1033468855 NPI number — MRS. TAWNYA NICOLE VULTAGGIO RN

Table of content: MRS. TAWNYA NICOLE VULTAGGIO RN (NPI 1033468855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033468855 NPI number — MRS. TAWNYA NICOLE VULTAGGIO RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VULTAGGIO
Provider First Name:
TAWNYA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FARR
Provider Other First Name:
TAWNYA
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033468855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9448D FEW LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT DRUM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13603-3204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-907-9201
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9448D FEW LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT DRUM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13603-3204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-907-9201
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2012

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: 163W00000X , with the licence number:  658555 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com