1467720276 NPI number — MRS. VANIA ZANETA COSTNER LCAS-A

Table of content: MRS. VANIA ZANETA COSTNER LCAS-A (NPI 1467720276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467720276 NPI number — MRS. VANIA ZANETA COSTNER LCAS-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COSTNER
Provider First Name:
VANIA
Provider Middle Name:
ZANETA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCAS-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COSTNER
Provider Other First Name:
VANIA
Provider Other Middle Name:
ZANETA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
VANIA Z. COSTNER
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1467720276
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 E WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27401-2993
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-333-6860
Provider Business Mailing Address Fax Number:
336-275-1187

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 E WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27401-2993
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-333-6860
Provider Business Practice Location Address Fax Number:
336-275-1187
Provider Enumeration Date:
12/07/2011

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6006903 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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