1386886703 NPI number — MRS. JANIE DARLENE HOLDER R EEG T, CNIM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386886703 NPI number — MRS. JANIE DARLENE HOLDER R EEG T, CNIM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLDER
Provider First Name:
JANIE
Provider Middle Name:
DARLENE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R EEG T, CNIM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CUMBA
Provider Other First Name:
JANIE
Provider Other Middle Name:
DARLENE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
REEGT, CNIM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386886703
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10934 POWER SQUADRON RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AZLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-368-1980
Provider Business Mailing Address Fax Number:
817-406-8350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10934 POWER SQUADRON RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AZLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-368-1980
Provider Business Practice Location Address Fax Number:
817-406-8350
Provider Enumeration Date:
03/31/2009

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: 246ZE0500X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 246ZE0600X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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