1144688383 NPI number — DALENA ELIZABETH DEKOWSKI RN, FNP-C

Table of content: DR. WALTER R. MAIN D.C. (NPI 1780690289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144688383 NPI number — DALENA ELIZABETH DEKOWSKI RN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEKOWSKI
Provider First Name:
DALENA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAGAN
Provider Other First Name:
DALENA
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144688383
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 CARL RAMERT DR
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
YOAKUM
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77995-4868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-293-7061
Provider Business Mailing Address Fax Number:
361-293-6559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 CARL RAMERT DR
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
YOAKUM
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77995-4868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-293-7061
Provider Business Practice Location Address Fax Number:
361-293-6559
Provider Enumeration Date:
02/02/2016

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: 363LF0000X , with the licence number:  AP130188 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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