1457491219 NPI number — DR. NANCY ANN ARQUETTE M.D.

Table of content: DR. NANCY ANN ARQUETTE M.D. (NPI 1457491219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457491219 NPI number — DR. NANCY ANN ARQUETTE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARQUETTE
Provider First Name:
NANCY
Provider Middle Name:
ANN
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:
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:
1457491219
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9222 STABLE CREEK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYLVANIA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43560-9291
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-262-3668
Provider Business Mailing Address Fax Number:
419-475-2356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6135 TRUST DR
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
HOLLAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43528-9358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-887-8727
Provider Business Practice Location Address Fax Number:
419-491-0042
Provider Enumeration Date:
02/08/2007

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: 207V00000X , with the licence number:  P18078 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 35090397 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P18078 . This is a "UMP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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