1558813956 NPI number — JAACQUELYN JOHNSON BA SOCIOLOGY

Table of content: JAACQUELYN JOHNSON BA SOCIOLOGY (NPI 1558813956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558813956 NPI number — JAACQUELYN JOHNSON BA SOCIOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
JAACQUELYN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BA SOCIOLOGY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COATES
Provider Other First Name:
JACQUELYN
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BA SOCIOLOGY
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558813956
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2207 IOELA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KILAUEA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96754-5321
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:
2207 IOELA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KILAUEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96754-5321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-360-6614
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2016

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: 106E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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