1487785556 NPI number — DEIDRA LANE RASNICK RN

Table of content: DEIDRA LANE RASNICK RN (NPI 1487785556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487785556 NPI number — DEIDRA LANE RASNICK RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RASNICK
Provider First Name:
DEIDRA
Provider Middle Name:
LANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
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:
1487785556
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:
DEPARTMENT 888182
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37995-8182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-355-3565
Provider Business Mailing Address Fax Number:
423-714-2355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4330 MAYNARDVILLE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYNARDVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-992-3849
Provider Business Practice Location Address Fax Number:
865-992-5166
Provider Enumeration Date:
03/08/2007

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: 163WP0808X , with the licence number:  RN49182 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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