1043268162 NPI number — MS. JANICE MARIE FREDERICK HIS

Table of content: MS. JANICE MARIE FREDERICK HIS (NPI 1043268162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043268162 NPI number — MS. JANICE MARIE FREDERICK HIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREDERICK
Provider First Name:
JANICE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
HIS
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:
1043268162
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10831 W BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN ALLEN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23060-3311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-716-6752
Provider Business Mailing Address Fax Number:
804-716-6754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10831 W BROAD ST
Provider Second Line Business Practice Location Address:
HEARING CONCEPTS
Provider Business Practice Location Address City Name:
GLEN ALLEN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-716-6752
Provider Business Practice Location Address Fax Number:
804-716-6754
Provider Enumeration Date:
05/04/2006

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: 163W00000X , with the licence number:  0001136796 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X , with the licence number: 2101002102 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com