1477867992 NPI number — ASSMCA

Table of content: AMANDA JEAN WATKINS FNP (NPI 1417223777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477867992 NPI number — ASSMCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSMCA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1477867992
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
VILLAS DE SAN AGUSTIN II CALLE 9 M37
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-374-9208
Provider Business Mailing Address Fax Number:
787-995-5174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
M37 CALLE 9
Provider Second Line Business Practice Location Address:
URB VILLAS DE SAN AGUSTIN II
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959-2000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-374-9208
Provider Business Practice Location Address Fax Number:
787-995-5174
Provider Enumeration Date:
07/27/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
REYNALDO
Authorized Official Middle Name:
Authorized Official Title or Position:
NURSING
Authorized Official Telephone Number:
787-374-9208

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  2340 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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