1306203393 NPI number — IVA DARKINA WARD MS, LAT, ATC

Table of content: IVA DARKINA WARD MS, LAT, ATC (NPI 1306203393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306203393 NPI number — IVA DARKINA WARD MS, LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARD
Provider First Name:
IVA
Provider Middle Name:
DARKINA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LAT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WARD
Provider Other First Name:
IVA
Provider Other Middle Name:
DARKINA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, LAT,ATC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1306203393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2011 GLENGATE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27560-6967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-385-6415
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WILLIAM B AYCOCK BUILDING
Provider Second Line Business Practice Location Address:
590 MANNING DRIVE , CAMPUS BOX 7595
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27599-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
984-984-2257
Provider Business Practice Location Address Fax Number:
919-966-6126
Provider Enumeration Date:
01/21/2016

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: 2255A2300X , with the licence number:  LAT-1653 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LAT-1653 . This is a "LICENCED ATHLETIC TRAINER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2000000710 . This is a "ATHLETIC TRANIER CARTIFIED" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".