1295932911 NPI number — DARLENE KIM LAKIN RN

Table of content: DARLENE KIM LAKIN RN (NPI 1295932911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295932911 NPI number — DARLENE KIM LAKIN RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAKIN
Provider First Name:
DARLENE
Provider Middle Name:
KIM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WRIGHT
Provider Other First Name:
DARLENE
Provider Other Middle Name:
KIM
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295932911
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:
1728 FOREST RIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRAVERSE CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49686-4799
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-631-8423
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6100 US 31 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMBURG
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-938-5983
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2007

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: 163W00000X , with the licence number:  4704214456 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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