1316951247 NPI number — DR. NANCY A DIDRIKSEN PHD

Table of content: DR. NANCY A DIDRIKSEN PHD (NPI 1316951247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316951247 NPI number — DR. NANCY A DIDRIKSEN PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIDRIKSEN
Provider First Name:
NANCY
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1316951247
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
997 HAMPSHIRE LANE
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
RICHARDSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75080-8104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-889-9933
Provider Business Mailing Address Fax Number:
972-889-9935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
997 HAMPSHIRE LANE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
RICHARDSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75080-8104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-889-9933
Provider Business Practice Location Address Fax Number:
972-889-9935
Provider Enumeration Date:
07/28/2006

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: 103G00000X , with the licence number:  23529 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 179804900 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 179804900 . This is a "OWCP INDIVIDUAL PROVIDER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 680009955 . This is a "RR MEDICARE PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com