1467753772 NPI number — MRS. DANA DELASKI NP-C

Table of content: MRS. DANA DELASKI NP-C (NPI 1467753772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467753772 NPI number — MRS. DANA DELASKI NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELASKI
Provider First Name:
DANA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP-C
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:
1467753772
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 N STATE ST
Provider Second Line Business Mailing Address:
DEPT OF MEDICINE-HEMATOLOGY
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39216-4500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-984-6426
Provider Business Mailing Address Fax Number:
601-984-6439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 N STATE ST
Provider Second Line Business Practice Location Address:
DEPT OF HEMATOLOGY
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39216-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-984-5615
Provider Business Practice Location Address Fax Number:
601-984-5689
Provider Enumeration Date:
11/03/2010

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:  R860432 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P01228850 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 01726582 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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