1144675752 NPI number — MRS. SUSAN CHRISTIAN EDKINS LAT, ATC

Table of content: MRS. SUSAN CHRISTIAN EDKINS LAT, ATC (NPI 1144675752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144675752 NPI number — MRS. SUSAN CHRISTIAN EDKINS LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDKINS
Provider First Name:
SUSAN
Provider Middle Name:
CHRISTIAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LAT, ATC
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:
1144675752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE UNIVERSITY DRIVE
Provider Second Line Business Mailing Address:
HHP DEPT. UNC PEMBROKE
Provider Business Mailing Address City Name:
PEMBROKE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28372-1510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-521-6480
Provider Business Mailing Address Fax Number:
910-775-4125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 UNIVERSITY RD
Provider Second Line Business Practice Location Address:
HHP DEPT. UNC PEMBROKE
Provider Business Practice Location Address City Name:
PEMBROKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28372-8699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-521-6480
Provider Business Practice Location Address Fax Number:
910-775-4125
Provider Enumeration Date:
05/02/2016

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: 2255A2300X , with the licence number:  0104 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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