1295700698 NPI number — CAROLYN LOUISE KRENKEL NP

Table of content: CAROLYN LOUISE KRENKEL NP (NPI 1295700698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295700698 NPI number — CAROLYN LOUISE KRENKEL NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRENKEL
Provider First Name:
CAROLYN
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1295700698
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10900 NUCKOLS RD 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN ALLEN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23060-9246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-396-6412
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5261 CARROLLTON PIKE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
WOODLAWN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24381-3030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-238-8876
Provider Business Practice Location Address Fax Number:
276-238-8886
Provider Enumeration Date:
02/20/2006

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: 363L00000X , with the licence number:  0024171506 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 261083931 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: C10361 . This is a "GROUP ORGANIZATION PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1295700698 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DN2980 . This is a "GROUP PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: Q52983 . This is a "PTAN" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com