1710414719 NPI number — MRS. ARIEL DEL RIO GRAHAM FNP-C

Table of content: MRS. ARIEL DEL RIO GRAHAM FNP-C (NPI 1710414719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710414719 NPI number — MRS. ARIEL DEL RIO GRAHAM FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAHAM
Provider First Name:
ARIEL
Provider Middle Name:
DEL RIO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALLS
Provider Other First Name:
ARIEL
Provider Other Middle Name:
DEL RIO
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710414719
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
254 HIGHWAY 3048
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAYVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71269-3624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-728-8416
Provider Business Mailing Address Fax Number:
318-728-8107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
256 HIGHWAY 3048
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAYVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71269-3624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-728-2046
Provider Business Practice Location Address Fax Number:
318-728-9371
Provider Enumeration Date:
05/22/2017

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: 363LP2300X , with the licence number:  AP09421 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: RN138403 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: RN138403 . This is a "REGISTERED NURSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 2449761 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AP09421 . This is a "ADVANCED NURSE PRACTITIONER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com