1366867533 NPI number — RASHEMA VANDETTA WARREN BS BACHELORS

Table of content: RASHEMA VANDETTA WARREN BS BACHELORS (NPI 1366867533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366867533 NPI number — RASHEMA VANDETTA WARREN BS BACHELORS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARREN
Provider First Name:
RASHEMA
Provider Middle Name:
VANDETTA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BS BACHELORS
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:
1366867533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 VILLA NOVA STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUTHBERT
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
39840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-732-5276
Provider Business Mailing Address Fax Number:
229-732-5090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 VILLA NOVA STREET
Provider Second Line Business Practice Location Address:
NEW HORIZONS
Provider Business Practice Location Address City Name:
CUTHBERT
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
39840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-732-5276
Provider Business Practice Location Address Fax Number:
229-732-5090
Provider Enumeration Date:
02/25/2014

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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