1366753873 NPI number — CARRIE MICHALSKI NURSE PRACTITIONER

Table of content: CARRIE MICHALSKI NURSE PRACTITIONER (NPI 1366753873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366753873 NPI number — CARRIE MICHALSKI NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHALSKI
Provider First Name:
CARRIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
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:
1366753873
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 E CARY ST
Provider Second Line Business Mailing Address:
SUITE 290
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23219-3816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-977-4488
Provider Business Mailing Address Fax Number:
434-977-6103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 PETER JEFFERSON PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 290
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22911-8835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-977-4488
Provider Business Practice Location Address Fax Number:
434-977-6103
Provider Enumeration Date:
06/30/2010

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: 363LW0102X , with the licence number:  0024167009 , 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)





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