1306088398 NPI number — MRS. DELORIS MITCHUSON LAKIA CNP

Table of content: MRS. DELORIS MITCHUSON LAKIA CNP (NPI 1306088398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306088398 NPI number — MRS. DELORIS MITCHUSON LAKIA CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAKIA
Provider First Name:
DELORIS
Provider Middle Name:
MITCHUSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MITCHUSON
Provider Other First Name:
DELORIS
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1306088398
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3000 ARLINGTON AVE
Provider Second Line Business Mailing Address:
UNIVERSITY OF TOLEDO COLLEGE OF MEDICINE MAILSTOP 1186
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43614-2595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-383-6858
Provider Business Mailing Address Fax Number:
419-383-6243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 ARLINGTON AVE
Provider Second Line Business Practice Location Address:
RUPPERT HEALTH CENTER ENDOCRINOLOGY
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43614-2595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-383-6612
Provider Business Practice Location Address Fax Number:
419-383-3336
Provider Enumeration Date:
04/06/2009

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:  170371 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 10446 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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