1023115458 NPI number — MRS. GEORGANA CEE TUDOR ARNP

Table of content: MRS. GEORGANA CEE TUDOR ARNP (NPI 1023115458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023115458 NPI number — MRS. GEORGANA CEE TUDOR ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TUDOR
Provider First Name:
GEORGANA
Provider Middle Name:
CEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023115458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4030 TATES CREEK RD
Provider Second Line Business Mailing Address:
APT 5604
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40517-3073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-200-9865
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 MAIN ST
Provider Second Line Business Practice Location Address:
SAINT LUKE'S FAMILY CLINIC
Provider Business Practice Location Address City Name:
CAMPTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41301-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-668-9076
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  5010P , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)