1679900518 NPI number — MRS. ALLISTER TENNILLE CATLETT LSW

Table of content: MRS. ALLISTER TENNILLE CATLETT LSW (NPI 1679900518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679900518 NPI number — MRS. ALLISTER TENNILLE CATLETT LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CATLETT
Provider First Name:
ALLISTER
Provider Middle Name:
TENNILLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAYE-CATLETT
Provider Other First Name:
ALLISTER
Provider Other Middle Name:
TENNILLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1679900518
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
512 UNION ST
Provider Second Line Business Mailing Address:
CRRT AT WATER'S EDGE
Provider Business Mailing Address City Name:
TRENTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08611-2800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-599-2778
Provider Business Mailing Address Fax Number:
609-599-2774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
512 UNION ST
Provider Second Line Business Practice Location Address:
CRRT AT WATER'S EDGE
Provider Business Practice Location Address City Name:
TRENTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08611-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-599-2778
Provider Business Practice Location Address Fax Number:
609-599-2774
Provider Enumeration Date:
10/10/2013

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: 104100000X , with the licence number:  44SL05076200 , 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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