1558004044 NPI number — FUGUANA CAMELA CHINIKA HAGGARD

Table of content: FUGUANA CAMELA CHINIKA HAGGARD (NPI 1558004044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558004044 NPI number — FUGUANA CAMELA CHINIKA HAGGARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAGGARD
Provider First Name:
FUGUANA
Provider Middle Name:
CAMELA CHINIKA
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:
MIDDLETON
Provider Other First Name:
FUGUANA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558004044
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2007 WHISPERING MEADOWS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65202-2999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-809-9233
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24634 RUSTLER LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHLAND
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65556-7200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-809-9233
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2022

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com