1861532657 NPI number — MS. ANDREA LYNN VANSCOIK RD, CDCES

Table of content: MS. ANDREA LYNN VANSCOIK RD, CDCES (NPI 1861532657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861532657 NPI number — MS. ANDREA LYNN VANSCOIK RD, CDCES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANSCOIK
Provider First Name:
ANDREA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RD, CDCES
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:
1861532657
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 POCOSHOCK PL STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH CHESTERFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23235-6345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-287-4598
Provider Business Mailing Address Fax Number:
804-674-4145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 POCOSHOCK PL STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH CHESTERFIELD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23235-6345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-764-7885
Provider Business Practice Location Address Fax Number:
804-674-4145
Provider Enumeration Date:
02/08/2007

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: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1447212592 . This is a "HOSPITAL" identifier . This identifiers is of the category "OTHER".