1326808056 NPI number — ALLEN WAYNE HARPER

Table of content: ALLEN WAYNE HARPER (NPI 1326808056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326808056 NPI number — ALLEN WAYNE HARPER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARPER
Provider First Name:
ALLEN
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1326808056
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2738 WOODRUFF AVE APT 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48912-4456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
151-770-6153
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 N WAVERLY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48917-2846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-706-1539
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2024

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: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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