1336494400 NPI number — TASHAE DUPREE ADMINISTRATOR

Table of content: TASHAE DUPREE ADMINISTRATOR (NPI 1336494400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336494400 NPI number — TASHAE DUPREE ADMINISTRATOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUPREE
Provider First Name:
TASHAE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ADMINISTRATOR
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:
1336494400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
609 ORR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
N LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-688-2079
Provider Business Mailing Address Fax Number:
702-658-8702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
609 ORR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89030-5688
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-688-2079
Provider Business Practice Location Address Fax Number:
702-658-8702
Provider Enumeration Date:
07/16/2012

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: 376G00000X , with the licence number:  7368HIC-0 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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