1386085850 NPI number — BURGDORF BANK OF AMERICA HEALTH CENTER

Table of content: CHELSIE NOELLE NOLAN RN (NPI 1285487355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386085850 NPI number — BURGDORF BANK OF AMERICA HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BURGDORF BANK OF AMERICA HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1386085850
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 COVENTRY ST
Provider Second Line Business Mailing Address:
2ND FLOOR ADMINISTRATION
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06112-1548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-714-2813
Provider Business Mailing Address Fax Number:
860-714-8541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 COVENTRY ST
Provider Second Line Business Practice Location Address:
2ND FLOOR ADMINISTRATION
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06112-1548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-714-2813
Provider Business Practice Location Address Fax Number:
860-714-8541
Provider Enumeration Date:
07/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GOULD
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
SITE DIRECTOR
Authorized Official Telephone Number:
860-714-3690

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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