1780997668 NPI number — MRS. KATHLYN WATSON HANAUER M.S., C.G.C.

Table of content: MRS. KATHLYN WATSON HANAUER M.S., C.G.C. (NPI 1780997668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780997668 NPI number — MRS. KATHLYN WATSON HANAUER M.S., C.G.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANAUER
Provider First Name:
KATHLYN
Provider Middle Name:
WATSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., C.G.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WATSON
Provider Other First Name:
KATHLYN
Provider Other Middle Name:
A.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., C.G.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780997668
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11111 PARK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28226-4676
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-520-6762
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1718 E 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 404
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28204-3261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-384-5393
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2010

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: 170300000X , with the licence number:  14455 , 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)





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