1265542252 NPI number — DELORIS K VANDERHOOF CRNA

Table of content: DELORIS K VANDERHOOF CRNA (NPI 1265542252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265542252 NPI number — DELORIS K VANDERHOOF CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANDERHOOF
Provider First Name:
DELORIS
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1265542252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7763 DOYLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAINGSBURG
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48848-9791
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-945-2176
Provider Business Mailing Address Fax Number:
269-945-0885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1009 W GREEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HASTINGS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49058-1710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-945-3451
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2006

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: 367500000X , with the licence number:  4704141918 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4638500 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00155739 . This is a "PALMETTO GBA RR RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4308703890 . This is a "BCBS MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com