1659559144 NPI number — ANGEL LENORA RICHARDSON WALLS RPSGT

Table of content: ANGEL LENORA RICHARDSON WALLS RPSGT (NPI 1659559144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659559144 NPI number — ANGEL LENORA RICHARDSON WALLS RPSGT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARDSON WALLS
Provider First Name:
ANGEL
Provider Middle Name:
LENORA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPSGT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RICHARDSON
Provider Other First Name:
ANGEL
Provider Other Middle Name:
LENORA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RRT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659559144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
154 HAMAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19904-4883
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-744-9940
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
154 HAMAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19904-4883
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-744-9940
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2008

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: 227900000X , with the licence number:  C9-0000721 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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