1568459766 NPI number — MRS. MAUREEN THERESA LANG MA CCCA

Table of content: MRS. MAUREEN THERESA LANG MA CCCA (NPI 1568459766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568459766 NPI number — MRS. MAUREEN THERESA LANG MA CCCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANG
Provider First Name:
MAUREEN
Provider Middle Name:
THERESA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA CCCA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STRYKER
Provider Other First Name:
MAUREEN
Provider Other Middle Name:
THERESA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568459766
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75-5591 PALANI RD
Provider Second Line Business Mailing Address:
#206
Provider Business Mailing Address City Name:
KAILUA KONA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96740-3631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-329-0943
Provider Business Mailing Address Fax Number:
808-329-0943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75-5591 PALANI RD
Provider Second Line Business Practice Location Address:
#206
Provider Business Practice Location Address City Name:
KAILUA KONA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96740-3631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-329-0943
Provider Business Practice Location Address Fax Number:
808-329-0943
Provider Enumeration Date:
10/03/2005

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: 231H00000X , with the licence number:  AUD91 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237600000X , with the licence number: HA112 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 55491600 . This is a "ALOHA CARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: AUD91 . This is a "MDX" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000249490 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 521527 . This is a "HMN/HMA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 55491601 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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