1548730880 NPI number — MRS. ROCHELL GERONIMO REEDER PT

Table of content: MRS. ROCHELL GERONIMO REEDER PT (NPI 1548730880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548730880 NPI number — MRS. ROCHELL GERONIMO REEDER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REEDER
Provider First Name:
ROCHELL
Provider Middle Name:
GERONIMO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GERONIMO
Provider Other First Name:
ROCHELL
Provider Other Middle Name:
KONG
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548730880
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PSC 76 BOX 4098
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96319-0041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2003 1A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YOKOTA AIR FORCE BASE
Provider Business Practice Location Address State Name:
TOKYO
Provider Business Practice Location Address Postal Code:
96326
Provider Business Practice Location Address Country Code:
JP
Provider Business Practice Location Address Telephone Number:
754-281-6917
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/29/2018

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: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT5395 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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