1891823530 NPI number — TRESSA G CHENEY NURSE PRACTITIONER

Table of content: TRESSA G CHENEY NURSE PRACTITIONER (NPI 1891823530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891823530 NPI number — TRESSA G CHENEY NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHENEY
Provider First Name:
TRESSA
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
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:
1891823530
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1310 BRAMPTON AVE
Provider Second Line Business Mailing Address:
OGEECHEE OB-GYN, P.C.
Provider Business Mailing Address City Name:
STATESBORO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30458-0851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-871-6206
Provider Business Mailing Address Fax Number:
912-681-8558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 BRAMPTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30458-0851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-871-6206
Provider Business Practice Location Address Fax Number:
912-681-8558
Provider Enumeration Date:
03/02/2007

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: 363LF0000X , with the licence number:  RN144963 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: RN144963NP , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 507850960A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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