1245469857 NPI number — MS. JODI MORAVEC MS, RD,LD, CDE,BCADM

Table of content: MS. JODI MORAVEC MS, RD,LD, CDE,BCADM (NPI 1245469857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245469857 NPI number — MS. JODI MORAVEC MS, RD,LD, CDE,BCADM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORAVEC
Provider First Name:
JODI
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, RD,LD, CDE,BCADM
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:
1245469857
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4241 KEYS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THE COLONY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75056-3233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-367-3270
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1708 COIT RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75075-5024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-467-0400
Provider Business Practice Location Address Fax Number:
469-467-7009
Provider Enumeration Date:
07/06/2009

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: 133V00000X , with the licence number:  DT81202 , 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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