1023248978 NPI number — ANDREANA STOCKEY IDMT

Table of content: ANDREANA STOCKEY IDMT (NPI 1023248978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023248978 NPI number — ANDREANA STOCKEY IDMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOCKEY
Provider First Name:
ANDREANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
IDMT
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:
1023248978
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PSC 36 BOX 207
Provider Second Line Business Mailing Address:
UNIT 4820 BLDG 476
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09456-0207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
441285714347
Provider Business Mailing Address Fax Number:
441285714509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 ABS/SG BLDG 476 UNIT 4820
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAF FAIRFORD
Provider Business Practice Location Address State Name:
UNITED KINGDOM
Provider Business Practice Location Address Postal Code:
GL7 4DL
Provider Business Practice Location Address Country Code:
GB
Provider Business Practice Location Address Telephone Number:
441285714347
Provider Business Practice Location Address Fax Number:
441285714509
Provider Enumeration Date:
07/24/2009

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: 1710I1003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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