1194966283 NPI number — JANE ROUSE RN, MS, CRC, LPC

Table of content: JANE ROUSE RN, MS, CRC, LPC (NPI 1194966283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194966283 NPI number — JANE ROUSE RN, MS, CRC, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROUSE
Provider First Name:
JANE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, MS, CRC, LPC
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:
1194966283
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3725 NATIONAL DR
Provider Second Line Business Mailing Address:
STE 123
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27612-4066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-781-3149
Provider Business Mailing Address Fax Number:
919-781-8593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3725 NATIONAL DR
Provider Second Line Business Practice Location Address:
STE 123
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27612-4066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-781-3149
Provider Business Practice Location Address Fax Number:
919-781-8593
Provider Enumeration Date:
03/18/2009

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: 101YP2500X , with the licence number:  647 , 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)

  • Identifier: 647 . This is a "LPC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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