1477567709 NPI number — GWEN ELLINGSON SWENBERG RPH CPP

Table of content: GWEN ELLINGSON SWENBERG RPH CPP (NPI 1477567709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477567709 NPI number — GWEN ELLINGSON SWENBERG RPH CPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWENBERG
Provider First Name:
GWEN
Provider Middle Name:
ELLINGSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH CPP
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:
1477567709
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 STONERIDGE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAPEL HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27514-9775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-968-4283
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNC CAMPUS HEALTH JAMES A TAYLOR BLDG
Provider Second Line Business Practice Location Address:
CB 7470
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27599-7470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-966-6556
Provider Business Practice Location Address Fax Number:
919-966-6431
Provider Enumeration Date:
07/29/2006

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: 183500000X , with the licence number:  08000 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com