1326157678 NPI number — LORRAINE NANETTE DIRAFFAELLO CRNA

Table of content: LORRAINE NANETTE DIRAFFAELLO CRNA (NPI 1326157678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326157678 NPI number — LORRAINE NANETTE DIRAFFAELLO CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIRAFFAELLO
Provider First Name:
LORRAINE
Provider Middle Name:
NANETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAFAELO
Provider Other First Name:
LORRAINE
Provider Other Middle Name:
NANETTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326157678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5665 NEW NORTHSIDE DR
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30328-5831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-874-5454
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 DELBON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TURLOCK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95382-2016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-667-4200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2006

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: 367500000X , with the licence number:  AP30004365 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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