1275593048 NPI number — MRS. JANICE HAKES WAGAMAN M.A.

Table of content: MRS. JANICE HAKES WAGAMAN M.A. (NPI 1275593048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275593048 NPI number — MRS. JANICE HAKES WAGAMAN M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAGAMAN
Provider First Name:
JANICE
Provider Middle Name:
HAKES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAKES
Provider Other First Name:
JANICE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275593048
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:
16C S 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17501-1331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-859-3531
Provider Business Mailing Address Fax Number:
717-859-1060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16C S 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17501-1331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-859-3531
Provider Business Practice Location Address Fax Number:
717-859-1060
Provider Enumeration Date:
03/24/2006

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: 103TC0700X , with the licence number:  PS005911L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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