1093945040 NPI number — ALINE FAWZI WIMBERLY OTR/L

Table of content: ALINE FAWZI WIMBERLY OTR/L (NPI 1093945040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093945040 NPI number — ALINE FAWZI WIMBERLY OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIMBERLY
Provider First Name:
ALINE
Provider Middle Name:
FAWZI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
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:
1093945040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
396 AUGUSTA PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-570-8918
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
396 AUGUSTA PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37043-6722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-570-8918
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2009

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: 225X00000X , with the licence number:  0000003971 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000000000000 . This is a "NOT SURE, I WORK FOR A HOSPITAL" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".