1700806015 NPI number — REGIONAL OFFICE OF EDUCATION #13

Table of content: MRS. DEUNDRA LORAINE GRAHAM FNP (NPI 1013669811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700806015 NPI number — REGIONAL OFFICE OF EDUCATION #13

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGIONAL OFFICE OF EDUCATION #13
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:
1700806015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
930B FAIRFAX STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLYLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-594-2432
Provider Business Mailing Address Fax Number:
618-594-7192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 SOUTH LINCOLN STREET
Provider Second Line Business Practice Location Address:
CHILD & FAMILY CONNECTIONS
Provider Business Practice Location Address City Name:
CENTRALIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62801-0900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-532-4919
Provider Business Practice Location Address Fax Number:
618-532-0856
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARRETT
Authorized Official First Name:
KERI
Authorized Official Middle Name:
J
Authorized Official Title or Position:
REGIONAL SUPERINTENDENT CLINTON MAR
Authorized Official Telephone Number:
618-594-2432

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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