1376755876 NPI number — MARY DIANE LINK RNC,NP

Table of content: EMILY S DOTSON (NPI 1447963418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376755876 NPI number — MARY DIANE LINK RNC,NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINK
Provider First Name:
MARY
Provider Middle Name:
DIANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RNC,NP
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:
1376755876
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6175 TURRET DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-532-0401
Provider Business Mailing Address Fax Number:
719-632-6118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
629 N. NEVADA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-596-3344
Provider Business Practice Location Address Fax Number:
719-632-6118
Provider Enumeration Date:
05/04/2007

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: 363LW0102X , with the licence number:  96143 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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