1063926350 NPI number — DANIELLE MARIE MARTIN - FAIRCHILD RN

Table of content: DANIELLE MARIE MARTIN - FAIRCHILD RN (NPI 1063926350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063926350 NPI number — DANIELLE MARIE MARTIN - FAIRCHILD RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN - FAIRCHILD
Provider First Name:
DANIELLE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
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:
FAIRCHILD
Provider Other First Name:
DANIELLE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1063926350
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 KRAUSE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18337-9553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6319 STATE ROUTE 97
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NARROWSBURG
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12764-5264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-587-8881
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2017

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: 163WH0200X , with the licence number:  675502 , 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)





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