1629123153 NPI number — MS. JEANANN LORANGER PERKINS PA-C

Table of content: MS. JEANANN LORANGER PERKINS PA-C (NPI 1629123153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629123153 NPI number — MS. JEANANN LORANGER PERKINS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERKINS
Provider First Name:
JEANANN
Provider Middle Name:
LORANGER
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LORANGER
Provider Other First Name:
JEAN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629123153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 HANGAR AVE, BLDG 2040, RM 4
Provider Second Line Business Mailing Address:
624TH ASTS
Provider Business Mailing Address City Name:
HICKAM AFB
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96853-5272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-448-7803
Provider Business Mailing Address Fax Number:
808-448-3113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 HANGAR AVE, BLDG 2040, RM 4
Provider Second Line Business Practice Location Address:
624TH ASTS
Provider Business Practice Location Address City Name:
HICKAM AFB
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96853-5272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-448-7803
Provider Business Practice Location Address Fax Number:
808-448-3113
Provider Enumeration Date:
01/24/2007

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: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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