1336479435 NPI number — MRS. AMALIA CRACIUNESCU FNP-C

Table of content: MRS. AMALIA CRACIUNESCU FNP-C (NPI 1336479435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336479435 NPI number — MRS. AMALIA CRACIUNESCU FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRACIUNESCU
Provider First Name:
AMALIA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MUDREAC
Provider Other First Name:
AMALIA
Provider Other Middle Name:
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:
1336479435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19875 N 51ST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85308-5114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-581-8998
Provider Business Mailing Address Fax Number:
623-581-6461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19875 N 51ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85308-5114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-581-8998
Provider Business Practice Location Address Fax Number:
623-581-6461
Provider Enumeration Date:
01/12/2010

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: 363LF0000X , with the licence number:  AP8935 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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