1477850576 NPI number — DAWN M HORAK

Table of content: DAWN M HORAK (NPI 1477850576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477850576 NPI number — DAWN M HORAK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORAK
Provider First Name:
DAWN
Provider Middle Name:
M
Provider Name Prefix Text:
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:
LAMIRANDE
Provider Other First Name:
SARAH
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1477850576
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 CRYSTAL AVE
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
DERRY
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03038-1702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-425-9206
Provider Business Mailing Address Fax Number:
603-216-5952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 CRYSTAL AVE
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
DERRY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03038-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-425-9206
Provider Business Practice Location Address Fax Number:
603-216-5952
Provider Enumeration Date:
02/25/2011

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: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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