1366796427 NPI number — MRS. MARZENA MARIANNA OKONIAK-WHITE

Table of content: MRS. MARZENA MARIANNA OKONIAK-WHITE (NPI 1366796427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366796427 NPI number — MRS. MARZENA MARIANNA OKONIAK-WHITE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OKONIAK-WHITE
Provider First Name:
MARZENA
Provider Middle Name:
MARIANNA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1366796427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 WINDSTAR BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46131-7379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-560-9022
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1070 W JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46131-2179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-736-1119
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2012

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: 224Z00000X , with the licence number:  32001752A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com