1104433440 NPI number — MISS ASHUTABOT E NKI III

Table of content: MISS ASHUTABOT E NKI III (NPI 1104433440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104433440 NPI number — MISS ASHUTABOT E NKI III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NKI
Provider First Name:
ASHUTABOT
Provider Middle Name:
E
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
III
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1104433440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26611 S CLARK ST SUITE 700,
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-381-4432
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2480 16TH ST NW APT 428
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20009-6703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-255-5021
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2020

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 45923860 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 754515 . This is a "NATIONAL CPR FOUNDATION" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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