1417004052 NPI number — MS. HEIDRUN M. DALTON

Table of content: MS. HEIDRUN M. DALTON (NPI 1417004052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417004052 NPI number — MS. HEIDRUN M. DALTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DALTON
Provider First Name:
HEIDRUN
Provider Middle Name:
M.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1417004052
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:
USAG-HEIDELBERG
Provider Second Line Business Mailing Address:
IMEU-HEI-HRA UNIT 2937
Provider Business Mailing Address City Name:
HEIDELBERG
Provider Business Mailing Address State Name:
BADEN WURTEMBERG
Provider Business Mailing Address Postal Code:
APO AE 09102
Provider Business Mailing Address Country Code:
DE
Provider Business Mailing Address Telephone Number:
06221577475
Provider Business Mailing Address Fax Number:
06221575265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USAG DARMSTADT
Provider Second Line Business Practice Location Address:
UNIT 29500 BOX 31
Provider Business Practice Location Address City Name:
DARMSTADT
Provider Business Practice Location Address State Name:
HESSEN
Provider Business Practice Location Address Postal Code:
APO AE 09175
Provider Business Practice Location Address Country Code:
DE
Provider Business Practice Location Address Telephone Number:
06151691710
Provider Business Practice Location Address Fax Number:
06151697579
Provider Enumeration Date:
01/05/2007

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: 101YA0400X , with the licence number:  4106 , 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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