1881636520 NPI number — CECILIA M ANSON-WONKKA MSRNCS

Table of content: CECILIA M ANSON-WONKKA MSRNCS (NPI 1881636520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881636520 NPI number — CECILIA M ANSON-WONKKA MSRNCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANSON-WONKKA
Provider First Name:
CECILIA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSRNCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANSON
Provider Other First Name:
CECILIA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSRNCS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881636520
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
319 BEECH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLYOKE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01040-3968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-540-1155
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
575 BEECH STREET
Provider Second Line Business Practice Location Address:
HOLYOKE MEDICAL CENTER
Provider Business Practice Location Address City Name:
HOLYOKE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-534-2500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2006

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: 364SP0809X , with the licence number:  175589 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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