1285880377 NPI number — KATRINA ADELE WAYMAN CNM

Table of content: KATRINA ADELE WAYMAN CNM (NPI 1285880377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285880377 NPI number — KATRINA ADELE WAYMAN CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAYMAN
Provider First Name:
KATRINA
Provider Middle Name:
ADELE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERGEVIN
Provider Other First Name:
KATRINA
Provider Other Middle Name:
ADELE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285880377
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 BIRCH ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
DERRY
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03038-2752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-421-2526
Provider Business Mailing Address Fax Number:
603-421-2568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 BIRCH ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
DERRY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03038-2752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-421-2526
Provider Business Practice Location Address Fax Number:
603-421-2568
Provider Enumeration Date:
08/08/2008

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: 367A00000X , with the licence number:  057811-23 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3086537 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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