1679560494 NPI number — MS. DIANA BETH HANNOCH-BOWIE A.P.N

Table of content: MS. DIANA BETH HANNOCH-BOWIE A.P.N (NPI 1679560494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679560494 NPI number — MS. DIANA BETH HANNOCH-BOWIE A.P.N

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANNOCH-BOWIE
Provider First Name:
DIANA
Provider Middle Name:
BETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
A.P.N
Provider Gender Code:
F

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:
1679560494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 95000 LB# 7550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19195-7550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-362-1735
Provider Business Mailing Address Fax Number:
973-290-7495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 ROUTE 23 NORTH
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
HAMBURG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-827-7800
Provider Business Practice Location Address Fax Number:
973-209-7855
Provider Enumeration Date:
10/06/2005

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: 363L00000X , with the licence number:  NN09766200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 26NN09766200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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