1669536934 NPI number — LAURA A SADEGHI CNP

Table of content: LAURA A SADEGHI CNP (NPI 1669536934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669536934 NPI number — LAURA A SADEGHI CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SADEGHI
Provider First Name:
LAURA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
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:
1669536934
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2610 NEW BERN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27610-1821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-803-4820
Provider Business Mailing Address Fax Number:
919-803-4821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KENT STATE UNIVERSITY HEALTH SERVICES
Provider Second Line Business Practice Location Address:
EASTWAY DRIVE
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44242-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-672-8248
Provider Business Practice Location Address Fax Number:
330-672-2272
Provider Enumeration Date:
12/21/2006

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: 363L00000X , with the licence number:  RN-207463 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2503562 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".