1306110499 NPI number — MRS. TERESE P DANA BC ABA

Table of content: MRS. TERESE P DANA BC ABA (NPI 1306110499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306110499 NPI number — MRS. TERESE P DANA BC ABA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DANA
Provider First Name:
TERESE
Provider Middle Name:
P
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BC ABA
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:
1306110499
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 434
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRYEBURG
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-935-1092
Provider Business Mailing Address Fax Number:
207-935-1092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2069 VILLAGE RD
Provider Second Line Business Practice Location Address:
MADISON ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-367-4642
Provider Business Practice Location Address Fax Number:
603-367-8784
Provider Enumeration Date:
03/07/2012

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: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11314501 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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