1124256037 NPI number — MISS NATHALIE GRACE CANETE HUSAIN PT

Table of content: MISS NATHALIE GRACE CANETE HUSAIN PT (NPI 1124256037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124256037 NPI number — MISS NATHALIE GRACE CANETE HUSAIN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUSAIN
Provider First Name:
NATHALIE GRACE
Provider Middle Name:
CANETE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1124256037
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
GMMPCPI 214 WEST 5TH ST.,
Provider Second Line Business Mailing Address:
SUITE D & E
Provider Business Mailing Address City Name:
JOPLIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-782-2917
Provider Business Mailing Address Fax Number:
417-782-7038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GMMPCPI 214 WEST 5TH ST.,
Provider Second Line Business Practice Location Address:
SUITE D & E
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-782-2917
Provider Business Practice Location Address Fax Number:
417-782-7038
Provider Enumeration Date:
06/30/2009

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: 225100000X , with the licence number:  070017146 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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