1184677668 NPI number — DR. JANICE STELLJES NAUMANN MD

Table of content: DR. JANICE STELLJES NAUMANN MD (NPI 1184677668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184677668 NPI number — DR. JANICE STELLJES NAUMANN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAUMANN
Provider First Name:
JANICE
Provider Middle Name:
STELLJES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STELLJES
Provider Other First Name:
JANICE
Provider Other Middle Name:
REGINA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184677668
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60447
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-0447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-333-4104
Provider Business Mailing Address Fax Number:
704-358-4544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2711 RANDOLPH RD
Provider Second Line Business Practice Location Address:
SUITE 512
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28207-2034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-333-4104
Provider Business Practice Location Address Fax Number:
704-358-4544
Provider Enumeration Date:
05/18/2006

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: 207V00000X , with the licence number:  9601137 , 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)

  • Identifier: 891084C , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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