1417126277 NPI number — DR. VICKI ZEMINA MUNSON-WHETSTONE M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417126277 NPI number — DR. VICKI ZEMINA MUNSON-WHETSTONE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNSON-WHETSTONE
Provider First Name:
VICKI
Provider Middle Name:
ZEMINA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MUNSON
Provider Other First Name:
VICKI
Provider Other Middle Name:
ZEMINA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417126277
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4242 HIGHWAY 19
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
ZACHARY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70791-3981
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-286-8100
Provider Business Mailing Address Fax Number:
225-286-8110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4242 HIGHWAY 19
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ZACHARY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70791-3981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-286-8100
Provider Business Practice Location Address Fax Number:
225-286-8110
Provider Enumeration Date:
02/26/2008

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: 207Q00000X , with the licence number:  202267 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1077933 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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