1295913259 NPI number — MISS ANITA DIANE WIEDMANN RPT

Table of content: MISS ANITA DIANE WIEDMANN RPT (NPI 1295913259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295913259 NPI number — MISS ANITA DIANE WIEDMANN RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIEDMANN
Provider First Name:
ANITA
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
RPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WIEDMANN
Provider Other First Name:
DIANE
Provider Other Middle Name:
ANITA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1295913259
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1609 RAWLINGS DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PICKERING
Provider Business Mailing Address State Name:
ONTARIO
Provider Business Mailing Address Postal Code:
L1V5B6
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
905-420-4203
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
580 HARWOOD AVE. S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AJAX
Provider Business Practice Location Address State Name:
ONTARIO
Provider Business Practice Location Address Postal Code:
L1S2J4
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
905-683-2320
Provider Business Practice Location Address Fax Number:
905-428-5204
Provider Enumeration Date:
02/01/2008

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: 225100000X , with the licence number:  5609 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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