1770767949 NPI number — JAMIE PANZERO

Table of content: NATALIE MARIA VERMITSKY LCSWA (NPI 1356118624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770767949 NPI number — JAMIE PANZERO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMIE PANZERO
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:
6
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:
1770767949
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1055
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOLDOTNA
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99669-1055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-398-2369
Provider Business Mailing Address Fax Number:
907-262-6690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36745 FUEDING LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STERLING
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-398-2369
Provider Business Practice Location Address Fax Number:
907-262-6690
Provider Enumeration Date:
12/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PANZERO
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
907-398-2369

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CMG874 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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