1992904429 NPI number — MRS. MIA N DEANE LMT

Table of content: MRS. MIA N DEANE LMT (NPI 1992904429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992904429 NPI number — MRS. MIA N DEANE LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEANE
Provider First Name:
MIA
Provider Middle Name:
N
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HULIN
Provider Other First Name:
MIA
Provider Other Middle Name:
N
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992904429
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2408 BELL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97504-1752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-261-6170
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1150 CRATER LAKE AVE
Provider Second Line Business Practice Location Address:
STE. G
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97504-6213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-857-4540
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2007

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: 225700000X , with the licence number:  13269 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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