1720315716 NPI number — GLORIA J HARGREAVES CST/CFA

Table of content: GLORIA J HARGREAVES CST/CFA (NPI 1720315716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720315716 NPI number — GLORIA J HARGREAVES CST/CFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARGREAVES
Provider First Name:
GLORIA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CST/CFA
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:
1720315716
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 FRANKLIN HEALTH CMNS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04938-6144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-778-9001
Provider Business Mailing Address Fax Number:
207-779-2913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 FRANKLIN HEALTH CMNS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04938-6144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-778-9001
Provider Business Practice Location Address Fax Number:
207-779-2913
Provider Enumeration Date:
11/11/2009

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: 246ZC0007X , with the licence number:  116715 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 116715 . This is a "CERTIFIED SURGICAL TECHNOLOGIST/CERTIFIED FIRST ASSIST" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".