1326367731 NPI number — RENAE JOAN SOULE' PT

Table of content: RENAE JOAN SOULE' PT (NPI 1326367731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326367731 NPI number — RENAE JOAN SOULE' PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOULE'
Provider First Name:
RENAE
Provider Middle Name:
JOAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MONIE
Provider Other First Name:
RENAE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326367731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1769
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLEBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20118-1769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-687-8181
Provider Business Mailing Address Fax Number:
540-687-8256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8986 LORTON STATION BLVD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
LORTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22079-4753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-546-0013
Provider Business Practice Location Address Fax Number:
703-546-0014
Provider Enumeration Date:
05/25/2010

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: 225100000X , with the licence number:  2305204238 , 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)