1023231750 NPI number — MS. ANNETTE GAUTHIER LEPORIS

Table of content: MS. ANNETTE GAUTHIER LEPORIS (NPI 1023231750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023231750 NPI number — MS. ANNETTE GAUTHIER LEPORIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEPORIS
Provider First Name:
ANNETTE
Provider Middle Name:
GAUTHIER
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OBI
Provider Other First Name:
ANNETTE
Provider Other Middle Name:
GAUTHIER
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023231750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 DUPONT CIR
Provider Second Line Business Mailing Address:
APT # 42
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27705-2937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-308-8292
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 DUPONT CIR
Provider Second Line Business Practice Location Address:
APT # 42
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27705-2937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-308-8292
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2007

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: 372500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 372600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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