1912984014 NPI number — MS. LIANNE MARGARET DEHNAM ANP BC

Table of content: MS. LIANNE MARGARET DEHNAM ANP BC (NPI 1912984014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912984014 NPI number — MS. LIANNE MARGARET DEHNAM ANP BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEHNAM
Provider First Name:
LIANNE
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ANP BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIPSKIND
Provider Other First Name:
LIANNE
Provider Other Middle Name:
MARGARET
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912984014
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1235 WHITEHORSE MERCERVILLE RD
Provider Second Line Business Mailing Address:
SUITE 316 BLDG. C
Provider Business Mailing Address City Name:
MERCERVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08619-3810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-581-5586
Provider Business Mailing Address Fax Number:
609-581-5779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1235 WHITEHORSE MERCERVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 316 BLDG. C
Provider Business Practice Location Address City Name:
MERCERVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08619-3810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-581-5586
Provider Business Practice Location Address Fax Number:
609-581-5779
Provider Enumeration Date:
12/29/2005

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: 207R00000X , with the licence number:  NN088588 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 26NN08858800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 223709512 . This is a "HORIZON" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: NN088588 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 500018409 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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