1992855878 NPI number — HEATHER LAYFIELD PA-C

Table of content: HEATHER LAYFIELD PA-C (NPI 1992855878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992855878 NPI number — HEATHER LAYFIELD PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAYFIELD
Provider First Name:
HEATHER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1992855878
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
380 LAFAYETTE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03842-2222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-926-0088
Provider Business Mailing Address Fax Number:
603-926-2853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 BORTHWICK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03801-7128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-433-4012
Provider Business Practice Location Address Fax Number:
603-926-2853
Provider Enumeration Date:
01/11/2007

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: 363A00000X , with the licence number:  103706 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 0747 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 435059199 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1992855878 . This is a "HEALTHNET TRICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30337795 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0382PA , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00807093 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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