1710969456 NPI number — WILLIAM CADWELL CRNA

Table of content: WILLIAM CADWELL CRNA (NPI 1710969456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710969456 NPI number — WILLIAM CADWELL CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CADWELL
Provider First Name:
WILLIAM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

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:
1710969456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1114 JOHN SIMS PKWY E PMB 381
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NICEVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32578-2204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
350-837-4716
Provider Business Mailing Address Fax Number:
350-699-2081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1114 JOHN SIMS PKWY, PMB381
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NICEVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-897-9792
Provider Business Practice Location Address Fax Number:
850-699-2081
Provider Enumeration Date:
11/17/2005

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: 367500000X , with the licence number:  058631 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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