1255704896 NPI number — MS. JULIE ANN NIELSEN HAD

Table of content: MS. JULIE ANN NIELSEN HAD (NPI 1255704896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255704896 NPI number — MS. JULIE ANN NIELSEN HAD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIELSEN
Provider First Name:
JULIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
HAD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NIELSEN
Provider Other First Name:
JULIE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
HEARINGAIDDISPENSER
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1255704896
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13900 MARQUESAS WAY APT 3115
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARINA DEL REY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90292-6024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-251-9218
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3701 SKYPARK DR
Provider Second Line Business Practice Location Address:
150
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90505-4753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-802-7933
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2015

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: 237700000X , with the licence number:  HA8006 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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