1477649523 NPI number — MS. MAYBELLE HOLIDAY-DESCHENY ARRT RT

Table of content: MS. MAYBELLE HOLIDAY-DESCHENY ARRT RT (NPI 1477649523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477649523 NPI number — MS. MAYBELLE HOLIDAY-DESCHENY ARRT RT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLIDAY-DESCHENY
Provider First Name:
MAYBELLE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARRT RT
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:
1477649523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 62
Provider Second Line Business Mailing Address:
2008 2 RED 420 MESCAL LOOP
Provider Business Mailing Address City Name:
MESCALERO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88340-0062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-464-4441
Provider Business Mailing Address Fax Number:
505-464-4422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
318 ABALONE LOOP
Provider Second Line Business Practice Location Address:
MESCALERO INDIAN HOSPITAL
Provider Business Practice Location Address City Name:
MESCALERO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88340-0210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-404-4441
Provider Business Practice Location Address Fax Number:
505-464-4422
Provider Enumeration Date:
10/05/2006

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: 247100000X , with the licence number:  183510R , registered in the state of MN ; 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