1619930666 NPI number — DIRECT RESPIRATORY SERVICES

Table of content: MRS. JENNISE LURREL DAWKINS CNM (NPI 1528664547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619930666 NPI number — DIRECT RESPIRATORY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIRECT RESPIRATORY SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1619930666
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302A NORTH PIERCE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDEN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27288
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-627-0061
Provider Business Mailing Address Fax Number:
336-627-7003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302A NORTH PIERCE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDEN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-627-0061
Provider Business Practice Location Address Fax Number:
336-627-7003
Provider Enumeration Date:
04/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VERNON
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
GRIFFIN
Authorized Official Title or Position:
OWNER PARTNER
Authorized Official Telephone Number:
336-627-0061

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  01008 , 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)

  • Identifier: 7704270 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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