1952637795 NPI number — DORIS R ANUKAM APRN

Table of content: DORIS R ANUKAM APRN (NPI 1952637795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952637795 NPI number — DORIS R ANUKAM APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANUKAM
Provider First Name:
DORIS
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
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:
1952637795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6190 MAE ANNE AVE STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89523-4709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-418-5990
Provider Business Mailing Address Fax Number:
775-418-5991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6190 MAE ANNE AVE STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89523-4709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-418-5990
Provider Business Practice Location Address Fax Number:
775-418-5991
Provider Enumeration Date:
10/29/2009

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: 363LP0808X , with the licence number:  841181 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: 25039 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 25039 . This is a "REGISTERED NURSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 841181 . This is a "APRN-CNP" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".