1568992287 NPI number — AMANDA LYNNE WOJAHN MD

Table of content: MCKYLA WALKER (NPI 1699635706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568992287 NPI number — AMANDA LYNNE WOJAHN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOJAHN
Provider First Name:
AMANDA
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1568992287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
U.S. NAVAL HOSPITAL GUAM EMERGENCY DEPARTMENT
Provider Second Line Business Mailing Address:
PSC 455 BOX 208
Provider Business Mailing Address City Name:
FPO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
U.S. NAVAL HOSPITAL GUAM
Provider Second Line Business Practice Location Address:
FARENHOLT AVE, BLDG 50
Provider Business Practice Location Address City Name:
AGANA HEIGHTS
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-344-9222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2017

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: 171000000X , with the licence number:  01081037A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: A174590 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171000000X , with the licence number: A174590 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 01081037A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: M-2398 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: VAD0000 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".