1164471538 NPI number — NECOE LYNNN OTTO-PARKINSON PHD

Table of content: NECOE LYNNN OTTO-PARKINSON PHD (NPI 1164471538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164471538 NPI number — NECOE LYNNN OTTO-PARKINSON PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OTTO-PARKINSON
Provider First Name:
NECOE
Provider Middle Name:
LYNNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1164471538
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 E RIVER RD
Provider Second Line Business Mailing Address:
SUITE 121
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85718-6579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-971-5578
Provider Business Mailing Address Fax Number:
520-297-7002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6837 N ORACLE RD
Provider Second Line Business Practice Location Address:
UNIT 14
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85704-4292
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-971-5578
Provider Business Practice Location Address Fax Number:
520-297-7002
Provider Enumeration Date:
05/10/2006

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: 103TC0700X , with the licence number:  3438 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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