1366613648 NPI number — MRS. LORRAINA NYANZA MSW LISW MAC

Table of content: MRS. LORRAINA NYANZA MSW LISW MAC (NPI 1366613648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366613648 NPI number — MRS. LORRAINA NYANZA MSW LISW MAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NYANZA
Provider First Name:
LORRAINA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LISW MAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES
Provider Other First Name:
LORRAINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366613648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CMR 431 BOX 2456
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09175
Provider Business Mailing Address Country Code:
DE
Provider Business Mailing Address Telephone Number:
011496151691710
Provider Business Mailing Address Fax Number:
011496151697579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CAMBRAI FRITSCH KASEM BLDG 4006 RM 305
Provider Second Line Business Practice Location Address:
ARMY SUBSTANCE ABUSE PROGRAM
Provider Business Practice Location Address City Name:
DARMSTADT
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
APO
Provider Business Practice Location Address Country Code:
DE
Provider Business Practice Location Address Telephone Number:
011496151691710
Provider Business Practice Location Address Fax Number:
011496151697579
Provider Enumeration Date:
03/14/2008

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: 104100000X , with the licence number:  LISWI05762 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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