1699030221 NPI number — MS. ALICE FAUSOLD PARRISH M.S.

Table of content: (NPI 1205952785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699030221 NPI number — MS. ALICE FAUSOLD PARRISH M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARRISH
Provider First Name:
ALICE
Provider Middle Name:
FAUSOLD
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
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:
1699030221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2857 NW 5TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPE CORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33993-7061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-989-2918
Provider Business Mailing Address Fax Number:
239-275-9058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2789 ORTIZ AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33905-7806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-273-3222
Provider Business Practice Location Address Fax Number:
239-275-9058
Provider Enumeration Date:
07/10/2012

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 101Y0000X . This is a "TAXONOMIE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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