1770635187 NPI number — MRS. KATHERINE DELGADO JANTAC GNP-BC

Table of content: MRS. KATHERINE DELGADO JANTAC GNP-BC (NPI 1770635187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770635187 NPI number — MRS. KATHERINE DELGADO JANTAC GNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JANTAC
Provider First Name:
KATHERINE
Provider Middle Name:
DELGADO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
GNP-BC
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:
1770635187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6334 CEDAR LN
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21044-3898
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-531-2355
Provider Business Mailing Address Fax Number:
410-531-7041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6334 CEDAR LN
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21044-3898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-531-2355
Provider Business Practice Location Address Fax Number:
410-531-7041
Provider Enumeration Date:
01/17/2007

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: 363LG0600X , with the licence number:  R121680 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9680-0062 . This is a "CAREFIRST BCBS OF DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 263108258 . This is a "TRICARE NORTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 83-20152 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P516-0001 . This is a "CAREFIRST BCBS OF DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 417307400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 83-15248 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 948993-02 . This is a "CAREFIRST BCBS OF MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 948993-01 . This is a "CAREFIRST BCBS OF MD" identifier . This identifiers is of the category "OTHER".




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