1730451378 NPI number — TEIA R FLEMING CRNA

Table of content: TEIA R FLEMING CRNA (NPI 1730451378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730451378 NPI number — TEIA R FLEMING CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLEMING
Provider First Name:
TEIA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1730451378
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7700 WEST SUNRISE BLVD
Provider Second Line Business Mailing Address:
PL-14-MAIL
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33322-4113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-838-2371
Provider Business Mailing Address Fax Number:
954-851-1746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
403 BURKARTH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREBSBURG
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-747-2500
Provider Business Practice Location Address Fax Number:
816-335-4003
Provider Enumeration Date:
01/28/2012

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: 367500000X , with the licence number:  2012002916 , 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)