1346674983 NPI number — MR. STEPHEN TRADER ELLIOTT JR. REGISTERED NURSE

Table of content: MR. STEPHEN TRADER ELLIOTT JR. REGISTERED NURSE (NPI 1346674983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346674983 NPI number — MR. STEPHEN TRADER ELLIOTT JR. REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELLIOTT
Provider First Name:
STEPHEN
Provider Middle Name:
TRADER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
REGISTERED NURSE
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:
1346674983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
KAMC, NGH, MC 1, BUILDING 12, APT. 8
Provider Second Line Business Mailing Address:
PO BOX 9515, ER MAIL COSE 6338
Provider Business Mailing Address City Name:
JEDDAH
Provider Business Mailing Address State Name:
MAKKAH
Provider Business Mailing Address Postal Code:
21423
Provider Business Mailing Address Country Code:
SA
Provider Business Mailing Address Telephone Number:
50-798-6510
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KAMC, NGH, MC 1, BUILDING 12, APT. 8
Provider Second Line Business Practice Location Address:
ER MAIL COSE 6338
Provider Business Practice Location Address City Name:
JEDDAH
Provider Business Practice Location Address State Name:
MAKKAH
Provider Business Practice Location Address Postal Code:
21423
Provider Business Practice Location Address Country Code:
SA
Provider Business Practice Location Address Telephone Number:
50-798-6510
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2013

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: 163W00000X , with the licence number:  617505 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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