1134773930 NPI number — ANGELA DENISE GIVENS

Table of content: ANGELA DENISE GIVENS (NPI 1134773930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134773930 NPI number — ANGELA DENISE GIVENS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIVENS
Provider First Name:
ANGELA
Provider Middle Name:
DENISE
Provider Name Prefix Text:
Provider Name Suffix Text:
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:
1134773930
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1114 SOUTH DUPONT HIGHWAY
Provider Second Line Business Mailing Address:
STE 105 ATTN: JANINE COLEMAN
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-442-6194
Provider Business Mailing Address Fax Number:
302-672-8195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 OLD LANDING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLSBORO
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19966-1210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-947-1920
Provider Business Practice Location Address Fax Number:
302-947-4645
Provider Enumeration Date:
07/30/2019

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: 101YA0400X , with the licence number:  1615 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com