1447504675 NPI number — ALISON JO LEDWOROWSKI

Table of content: ALISON JO LEDWOROWSKI (NPI 1447504675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447504675 NPI number — ALISON JO LEDWOROWSKI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEDWOROWSKI
Provider First Name:
ALISON
Provider Middle Name:
JO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1447504675
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3325 RESEARCH WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARSON CITY
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89706-7913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-888-6610
Provider Business Mailing Address Fax Number:
775-888-4904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 CAMBRIDGE ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89119-7439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-307-5415
Provider Business Practice Location Address Fax Number:
702-307-5416
Provider Enumeration Date:
11/09/2012

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: 1041C0700X , with the licence number:  6843-C , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1447504675 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com