1124174818 NPI number — MS. DIANJE TURNER FITZSIMMONS R.PH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124174818 NPI number — MS. DIANJE TURNER FITZSIMMONS R.PH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FITZSIMMONS
Provider First Name:
DIANJE
Provider Middle Name:
TURNER
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
R.PH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CROUCH
Provider Other First Name:
DIANE
Provider Other Middle Name:
TURNER
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.PH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124174818
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 RUSTIC HIGHLANDS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HURRICANE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25526-9263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-757-3285
Provider Business Mailing Address Fax Number:
304-757-3285

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 SUGAR MAPLE LN
Provider Second Line Business Practice Location Address:
CHD MERIDIAN CENTER
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25033-9430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-937-7429
Provider Business Practice Location Address Fax Number:
304-937-7431
Provider Enumeration Date:
01/26/2007

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: 183500000X , with the licence number:  3318 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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