1083720536 NPI number — MEGAN CANAVERA BIES MS, RD, LDN

Table of content: MEGAN CANAVERA BIES MS, RD, LDN (NPI 1083720536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083720536 NPI number — MEGAN CANAVERA BIES MS, RD, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIES
Provider First Name:
MEGAN
Provider Middle Name:
CANAVERA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, LDN
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:
1083720536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37 ABIGAIL WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMERON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28326-6231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-322-4700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 RAMSEY ST
Provider Second Line Business Practice Location Address:
HOME BASED PRIMARY CARE
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28301-3856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-488-2120
Provider Business Practice Location Address Fax Number:
910-482-5040
Provider Enumeration Date:
08/21/2006

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: 133V00000X , with the licence number:  5597 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 951675 . This is a "CDR REGISTRATION" identifier . This identifiers is of the category "OTHER".




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