1326489766 NPI number — MS. LINDA JOYCE WASIELEWSKI NCC LPCA

Table of content: MS. LINDA JOYCE WASIELEWSKI NCC LPCA (NPI 1326489766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326489766 NPI number — MS. LINDA JOYCE WASIELEWSKI NCC LPCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WASIELEWSKI
Provider First Name:
LINDA
Provider Middle Name:
JOYCE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NCC LPCA
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:
1326489766
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 MILL LANDING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23322-8302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-549-0794
Provider Business Mailing Address Fax Number:
757-549-0794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 S WATER ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-4965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-338-0098
Provider Business Practice Location Address Fax Number:
252-335-1493
Provider Enumeration Date:
07/15/2013

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: 101YM0800X , with the licence number:  A10238 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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