1073979480 NPI number — MS. ANNA RUSLANOVNA DEGOLIER APRN-C, AGNP

Table of content: MS. ANNA RUSLANOVNA DEGOLIER APRN-C, AGNP (NPI 1073979480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073979480 NPI number — MS. ANNA RUSLANOVNA DEGOLIER APRN-C, AGNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEGOLIER
Provider First Name:
ANNA
Provider Middle Name:
RUSLANOVNA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN-C, AGNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOBLEY
Provider Other First Name:
ANNA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073979480
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 SOUTH BERETANIA ST., STE. 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-545-2800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 MANNING DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27514-4220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
984-974-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2016

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: 363L00000X , with the licence number:  APRN2051 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LG0600X , with the licence number: 5017297 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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