1760783518 NPI number — MRS. JUDY LORAINE CARVER RD,LD, CDE

Table of content: MRS. JUDY LORAINE CARVER RD,LD, CDE (NPI 1760783518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760783518 NPI number — MRS. JUDY LORAINE CARVER RD,LD, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARVER
Provider First Name:
JUDY
Provider Middle Name:
LORAINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD,LD, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUBBARD
Provider Other First Name:
JUDY
Provider Other Middle Name:
LORAINE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760783518
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 PORTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65605-2365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-678-7980
Provider Business Mailing Address Fax Number:
417-678-7864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 PORTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65605-2365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-678-7980
Provider Business Practice Location Address Fax Number:
417-678-7864
Provider Enumeration Date:
11/10/2010

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: 133V00000X , with the licence number:  2001007131 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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