1356742324 NPI number — DANNA OLINICK LCPC

Table of content: ANDREA ESMERALDA GARCIA ORTIZ CRNA (NPI 1710668280)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356742324 NPI number — DANNA OLINICK LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLINICK
Provider First Name:
DANNA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356742324
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
427 PEAR TREE POINT RD
Provider Second Line Business Mailing Address:
PO BOX 637
Provider Business Mailing Address City Name:
CHESTERTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21620-2342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-735-7815
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 HIGH ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
CHESTERTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21620-1326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-735-7815
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/10/2014

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: 101YM0800X , with the licence number:  5248852-6004 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LC5718 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0845051 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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