1285977710 NPI number — DR. CHARLOTTE ASTRID VIVIENNE VONN MD

Table of content: DR. CHARLOTTE ASTRID VIVIENNE VONN MD (NPI 1285977710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285977710 NPI number — DR. CHARLOTTE ASTRID VIVIENNE VONN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VONN
Provider First Name:
CHARLOTTE
Provider Middle Name:
ASTRID VIVIENNE
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:
MITCHELL
Provider Other First Name:
ANGELA
Provider Other Middle Name:
RAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1285977710
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W 134TH PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUT OFF
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70345-4143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-325-9333
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2106 LOOP RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINNSBORO
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71295-3344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-435-9411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2013

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: 207Q00000X , with the licence number:  MD.207500 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: MD.207500 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1D1629 . This is a "MEDICARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 14679366 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2329260 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P02480315 . This is a "RR MEDICARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com