1407994809 NPI number — MS. ANNMARIE MASSIMO OGNP

Table of content: MS. ANNMARIE MASSIMO OGNP (NPI 1407994809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407994809 NPI number — MS. ANNMARIE MASSIMO OGNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASSIMO
Provider First Name:
ANNMARIE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OGNP
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:
1407994809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
919 12TH PL
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
PRESCOTT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86305-1433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-778-4300
Provider Business Mailing Address Fax Number:
928-771-0920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
919 12TH PL
Provider Second Line Business Practice Location Address:
#1
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86305-1433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-778-4300
Provider Business Practice Location Address Fax Number:
928-771-0920
Provider Enumeration Date:
02/01/2007

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: 363LX0001X , with the licence number:  RN034359 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 557291 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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