1821277542 NPI number — IAN WHITMARSH CRNA

Table of content: IAN WHITMARSH CRNA (NPI 1821277542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821277542 NPI number — IAN WHITMARSH CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITMARSH
Provider First Name:
IAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

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:
1821277542
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7389
Provider Second Line Business Mailing Address:
ATTN: REBECCA EASON CPPA
Provider Business Mailing Address City Name:
LONGVIEW
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75607-7389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-260-6614
Provider Business Mailing Address Fax Number:
903-257-0815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 S UTICA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74104-4012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-579-5207
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2007

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: 367500000X , with the licence number:  AP30007888 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9655028 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: RN00123820 . This is a "RN LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: AP30007888 . This is a "WA LICENSE NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0093190 . This is a "REGISTERED NURSE/CRNA" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com