1689831273 NPI number — MRS. BERNADETTE SHARON HUNTER LPN

Table of content: MRS. BERNADETTE SHARON HUNTER LPN (NPI 1689831273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689831273 NPI number — MRS. BERNADETTE SHARON HUNTER LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUNTER
Provider First Name:
BERNADETTE
Provider Middle Name:
SHARON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
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:
1689831273
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
B STREET BLDG 29709
Provider Second Line Business Mailing Address:
CONNELLY HEALTH CLINIC ATTN DDEAMC
Provider Business Mailing Address City Name:
FT GORDON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30905-5650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-787-5174
Provider Business Mailing Address Fax Number:
706-787-5145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
B STREET BLDG 29709
Provider Second Line Business Practice Location Address:
CONNELLY HEALTH CLINIC ATTN DDEAMC
Provider Business Practice Location Address City Name:
FT GORDON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30905-5650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-787-5174
Provider Business Practice Location Address Fax Number:
706-787-5145
Provider Enumeration Date:
05/21/2008

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: 164W00000X , with the licence number:  LPN044950 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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