1659505451 NPI number — MAINE CDC PUBLIC HEALTH NURSING

Table of content: VICTORIA LYNETTE CORDOVA MS (NPI 1376212498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659505451 NPI number — MAINE CDC PUBLIC HEALTH NURSING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAINE CDC PUBLIC HEALTH NURSING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659505451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
286 WATER ST KEY PLZ FL 7
Provider Second Line Business Mailing Address:
STATE HOUSE STATION # 11
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04333-0011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-287-9025
Provider Business Mailing Address Fax Number:
207-287-5355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
286 WATER ST KEY PLZ FL 7
Provider Second Line Business Practice Location Address:
STATE HOUSE STATION # 11
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04333-0011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-287-9025
Provider Business Practice Location Address Fax Number:
207-287-5355
Provider Enumeration Date:
05/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LITTLEFIELD
Authorized Official First Name:
DWIGHT
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PUBLIC HEALTH NURSING CONSULTANT
Authorized Official Telephone Number:
207-287-9025

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 135910300 . This is a "BILLING PROVIDER NUMBER" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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