1366654089 NPI number — DEIRDRE R HIAM NURSE PRACTITIONER

Table of content: DEIRDRE R HIAM NURSE PRACTITIONER (NPI 1366654089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366654089 NPI number — DEIRDRE R HIAM NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HIAM
Provider First Name:
DEIRDRE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RICHARDSON
Provider Other First Name:
DEIRDRE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366654089
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 LAMPLIGHTER WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT HERMON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01354-9637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-498-3407
Provider Business Mailing Address Fax Number:
413-498-3147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 LAMPLIGHTER WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT HERMON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01354-9637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-498-3407
Provider Business Practice Location Address Fax Number:
413-498-3147
Provider Enumeration Date:
05/04/2007

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: 363LA2200X , with the licence number:  228669 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LS0200X , with the licence number: 228669 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 228669 . This is a "CONNECTICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0713457 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 126842 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: NP9544 . This is a "BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com