1124017017 NPI number — MRS. MELISSA KIMBERLY MAISENBACHER M.S.,C.G.C.

Table of content: MRS. MELISSA KIMBERLY MAISENBACHER M.S.,C.G.C. (NPI 1124017017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124017017 NPI number — MRS. MELISSA KIMBERLY MAISENBACHER M.S.,C.G.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAISENBACHER
Provider First Name:
MELISSA
Provider Middle Name:
KIMBERLY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.,C.G.C.
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:
1124017017
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8634 SW 66TH LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32608-5666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-376-8897
Provider Business Mailing Address Fax Number:
352-392-3051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 SW ARCHER RD
Provider Second Line Business Practice Location Address:
UF PEDIATRIC GENETICS
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32610-3003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-392-4104
Provider Business Practice Location Address Fax Number:
352-392-3051
Provider Enumeration Date:
10/14/2005

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: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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