1437250842 NPI number — MISS CANDIDA KATHRYN MAUST

Table of content: MISS CANDIDA KATHRYN MAUST (NPI 1437250842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437250842 NPI number — MISS CANDIDA KATHRYN MAUST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAUST
Provider First Name:
CANDIDA
Provider Middle Name:
KATHRYN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
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:
1437250842
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
USAMEDDAC WUERZBURG ATTN: CREDENTIALS OFFICE
Provider Second Line Business Mailing Address:
UNIT 26610
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
011499318043616
Provider Business Mailing Address Fax Number:
011499318043241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USAMEDDAC WUERZBURG EDIS CLINIC ANSBACH
Provider Second Line Business Practice Location Address:
235TH BSB UNIT 28614
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
011490981183811
Provider Business Practice Location Address Fax Number:
011490981183854
Provider Enumeration Date:
09/26/2006

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: 225XP0200X , with the licence number:  OT10733 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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