1083959621 NPI number — MS. ALICE DEUTSCH MENDYKOWSKI APRN

Table of content: MS. ALICE DEUTSCH MENDYKOWSKI APRN (NPI 1083959621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083959621 NPI number — MS. ALICE DEUTSCH MENDYKOWSKI APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENDYKOWSKI
Provider First Name:
ALICE
Provider Middle Name:
DEUTSCH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEUTSCH
Provider Other First Name:
ALICE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083959621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
46-078 EMEPELA PL APT J201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANEOHE
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96744-3960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-404-4859
Provider Business Mailing Address Fax Number:
808-263-5054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
642 ULUKAHIKI ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAILUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96734-4400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-263-5050
Provider Business Practice Location Address Fax Number:
808-263-5054
Provider Enumeration Date:
12/08/2012

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: 363L00000X , with the licence number:  1522 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: APRN-1522 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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