1750650008 NPI number — VETERANS AFFAIRS ANN ARBOR HEALTHCARE SYSTEM

Table of content: FERNANDO CARLOS ALFONSO CRNA (NPI 1699198952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750650008 NPI number — VETERANS AFFAIRS ANN ARBOR HEALTHCARE SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VETERANS AFFAIRS ANN ARBOR HEALTHCARE SYSTEM
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:
1750650008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2215 FULLER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48105-2303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-845-5094
Provider Business Mailing Address Fax Number:
734-222-6009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2215 FULLER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48105-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-845-5094
Provider Business Practice Location Address Fax Number:
734-222-6009
Provider Enumeration Date:
12/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MATHEWS
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
HUMAN RESOURCE SPECIALIST
Authorized Official Telephone Number:
734-845-5094

Provider Taxonomy Codes

  • Taxonomy code: 261QX0200X , with the licence number:  4704242477 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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