1134439250 NPI number — MRS. MARIE LOUISE JORIS PT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134439250 NPI number — MRS. MARIE LOUISE JORIS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JORIS
Provider First Name:
MARIE
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
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:
1134439250
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
457 CHEMIN DE MORMAL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MECQUIGNIES
Provider Business Mailing Address State Name:
FRANCE
Provider Business Mailing Address Postal Code:
59570
Provider Business Mailing Address Country Code:
FR
Provider Business Mailing Address Telephone Number:
0033327638286
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIT 21414 BOX 3530
Provider Second Line Business Practice Location Address:
SHAPE HEALTHCARE FACILITY
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09705-1414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
003265445892
Provider Business Practice Location Address Fax Number:
003265445919
Provider Enumeration Date:
10/08/2010

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:  51022790512 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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