1952389868 NPI number — DR. CYNTHIA MARY GRACIANETTE PH.D.

Table of content: DR. CYNTHIA MARY GRACIANETTE PH.D. (NPI 1952389868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952389868 NPI number — DR. CYNTHIA MARY GRACIANETTE PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRACIANETTE
Provider First Name:
CYNTHIA
Provider Middle Name:
MARY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1952389868
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
EDIS USNH NAPLES
Provider Second Line Business Mailing Address:
PSC 827 BOX 10
Provider Business Mailing Address City Name:
FPO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09617
Provider Business Mailing Address Country Code:
IT
Provider Business Mailing Address Telephone Number:
81-811-4676
Provider Business Mailing Address Fax Number:
81-811-4669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIS USNH NAPLES
Provider Second Line Business Practice Location Address:
PSC 827 BOX 10
Provider Business Practice Location Address City Name:
FPO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09617
Provider Business Practice Location Address Country Code:
IT
Provider Business Practice Location Address Telephone Number:
81-811-4676
Provider Business Practice Location Address Fax Number:
81-811-4669
Provider Enumeration Date:
01/03/2006

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: 103TC0700X , with the licence number:  524 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TC2200X , with the licence number: 524 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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