1194257758 NPI number — ANGELA L BAZEMORE QUAYE DBH, CFNC, RDMS, SAP

Table of content: ANGELA L BAZEMORE QUAYE DBH, CFNC, RDMS, SAP (NPI 1194257758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194257758 NPI number — ANGELA L BAZEMORE QUAYE DBH, CFNC, RDMS, SAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAZEMORE QUAYE
Provider First Name:
ANGELA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DBH, CFNC, RDMS, SAP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAZEMORE
Provider Other First Name:
ANGELA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DBH, CFNC, RDMS, SAP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194257758
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29697 N 69TH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85383-3178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-636-0686
Provider Business Mailing Address Fax Number:
602-532-7857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29697 N 69TH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85383-3178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-636-0686
Provider Business Practice Location Address Fax Number:
602-532-7857
Provider Enumeration Date:
03/31/2017

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: 133N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2471S1302X , with the licence number: 108395 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 814313295 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com