1144290040 NPI number — MRS. ANGELA DENISE HARDER COTA

Table of content: MRS. ANGELA DENISE HARDER COTA (NPI 1144290040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144290040 NPI number — MRS. ANGELA DENISE HARDER COTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARDER
Provider First Name:
ANGELA
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
COTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRUISE
Provider Other First Name:
ANGELA
Provider Other Middle Name:
DENISE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
COTA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144290040
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:
3312 PAVETTO LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-356-2545
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
359 E MORGAN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTINSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-349-7246
Provider Business Practice Location Address Fax Number:
765-349-1433
Provider Enumeration Date:
01/24/2006

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: 224Z00000X , with the licence number:  32000862A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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