1598964942 NPI number — NELSON CHRISTIANO ROURA II CPO

Table of content: (NPI 1215408208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598964942 NPI number — NELSON CHRISTIANO ROURA II CPO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROURA
Provider First Name:
NELSON
Provider Middle Name:
CHRISTIANO
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
CPO
Provider Gender Code:
M

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:
1598964942
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 SAINT LEO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27405-3382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-621-9500
Provider Business Mailing Address Fax Number:
336-621-0980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 SAINT LEO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27405-3382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-621-9500
Provider Business Practice Location Address Fax Number:
336-621-0980
Provider Enumeration Date:
07/16/2007

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: 1744P3200X , with the licence number:  C36315 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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