1437499464 NPI number — MRS. ROSALIND ELISE LONDON APRN

Table of content: MRS. ROSALIND ELISE LONDON APRN (NPI 1437499464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437499464 NPI number — MRS. ROSALIND ELISE LONDON APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONDON
Provider First Name:
ROSALIND
Provider Middle Name:
ELISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CANTRELL
Provider Other First Name:
ROSALIND
Provider Other Middle Name:
ELISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437499464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5200 COMMERCE CROSSINGS DR FL 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40229-2182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-253-4924
Provider Business Mailing Address Fax Number:
502-489-5750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2350 GREY LAG WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40509-2477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-263-3822
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2013

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: 363LF0000X , with the licence number:  3007816 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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