1063598159 NPI number — MS. ANN D GWIN L.C.S.W.

Table of content: MS. ANN D GWIN L.C.S.W. (NPI 1063598159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063598159 NPI number — MS. ANN D GWIN L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GWIN
Provider First Name:
ANN
Provider Middle Name:
D
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HASKETT
Provider Other First Name:
ANN
Provider Other Middle Name:
GWIN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.C.S.W.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063598159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1060 TODD PREIS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37221-2478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-646-7237
Provider Business Mailing Address Fax Number:
615-673-7749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 21ST AVE S
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37212-4927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-646-7237
Provider Business Practice Location Address Fax Number:
615-673-7749
Provider Enumeration Date:
10/31/2006

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: 1041C0700X , with the licence number:  0000000850 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 246697 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0191852 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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