1376532069 NPI number — MRS. LORA JEAN DRIVER BAMBERGER BA

Table of content: MRS. LORA JEAN DRIVER BAMBERGER BA (NPI 1376532069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376532069 NPI number — MRS. LORA JEAN DRIVER BAMBERGER BA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRIVER BAMBERGER
Provider First Name:
LORA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
O'CONNOR
Provider Other First Name:
LORA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376532069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 PROSPECT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-889-6147
Provider Business Mailing Address Fax Number:
603-883-1568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 PROSPECT ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-889-6147
Provider Business Practice Location Address Fax Number:
603-594-9649
Provider Enumeration Date:
10/17/2005

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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