1215098512 NPI number — MRS. LA NEICE LORRAINE ABDEL-SHAKUR CNM

Table of content: MRS. LA NEICE LORRAINE ABDEL-SHAKUR CNM (NPI 1215098512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215098512 NPI number — MRS. LA NEICE LORRAINE ABDEL-SHAKUR CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABDEL-SHAKUR
Provider First Name:
LA NEICE
Provider Middle Name:
LORRAINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PERKINS
Provider Other First Name:
LA NEICE
Provider Other Middle Name:
LORRAINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215098512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 BODIN CIR
Provider Second Line Business Mailing Address:
WOMEN'S HEALTH
Provider Business Mailing Address City Name:
TRAVIS AFB
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94535-1809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-423-5406
Provider Business Mailing Address Fax Number:
707-423-7356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 BODIN CIR
Provider Second Line Business Practice Location Address:
DAVID GRANT MEDICAL CENTER
Provider Business Practice Location Address City Name:
TRAVIS AFB
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94535-1809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-423-5406
Provider Business Practice Location Address Fax Number:
707-423-7356
Provider Enumeration Date:
12/12/2006

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: 163WX0003X , with the licence number:  704600 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: 1906 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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