1992900492 NPI number — PATRICE WANETTA DUMAS

Table of content: PATRICE WANETTA DUMAS (NPI 1992900492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992900492 NPI number — PATRICE WANETTA DUMAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUMAS
Provider First Name:
PATRICE
Provider Middle Name:
WANETTA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VERAGUTH
Provider Other First Name:
PATRICE
Provider Other Middle Name:
WANETTA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1992900492
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18813 E 25TH ST S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64057-2467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-217-1791
Provider Business Mailing Address Fax Number:
816-817-0027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18813 E 25TH ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64057-2467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-217-1791
Provider Business Practice Location Address Fax Number:
816-817-0027
Provider Enumeration Date:
06/15/2007

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: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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