1346586575 NPI number — MS. THERISA GIOVANA HEMINGWAY LPN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346586575 NPI number — MS. THERISA GIOVANA HEMINGWAY LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEMINGWAY
Provider First Name:
THERISA
Provider Middle Name:
GIOVANA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHAW
Provider Other First Name:
THERISA
Provider Other Middle Name:
GIOVANA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346586575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 WENDELL ST
Provider Second Line Business Mailing Address:
APT 29B
Provider Business Mailing Address City Name:
HEMPSTEAD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11550-1206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-492-2993
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 WENDELL ST
Provider Second Line Business Practice Location Address:
APT 29B
Provider Business Practice Location Address City Name:
HEMPSTEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11550-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-492-2993
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2012

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: 164W00000X , with the licence number:  094011 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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