1639142607 NPI number — MRS. DIANNE HENSGENS GRAHAM P.T.

Table of content: MRS. DIANNE HENSGENS GRAHAM P.T. (NPI 1639142607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639142607 NPI number — MRS. DIANNE HENSGENS GRAHAM P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAHAM
Provider First Name:
DIANNE
Provider Middle Name:
HENSGENS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENSGENS
Provider Other First Name:
DIANNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639142607
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:
7932 SUMMA AVE
Provider Second Line Business Mailing Address:
SUITE B3
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70809-3416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-769-9203
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7932 SUMMA AVE
Provider Second Line Business Practice Location Address:
SUITE B3
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70809-3416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-769-9203
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2006

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 , with the licence number:  04454 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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