1710380183 NPI number — MRS. CHRISTINE DIANA WITHERS REGISTERED NURSE

Table of content: MRS. CHRISTINE DIANA WITHERS REGISTERED NURSE (NPI 1710380183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710380183 NPI number — MRS. CHRISTINE DIANA WITHERS REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WITHERS
Provider First Name:
CHRISTINE
Provider Middle Name:
DIANA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED NURSE
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:
1710380183
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
703 E. 9TH STREET NORTH
Provider Second Line Business Mailing Address:
BLDG 4970, ROOM 123
Provider Business Mailing Address City Name:
FORT STEWART
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-435-1383
Provider Business Mailing Address Fax Number:
912-435-6133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
703 E. 9TH STREET NORTH
Provider Second Line Business Practice Location Address:
BLDG 4970, ROOM 123
Provider Business Practice Location Address City Name:
FORT STEWART
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-435-1383
Provider Business Practice Location Address Fax Number:
912-435-6133
Provider Enumeration Date:
09/30/2014

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: 163WC0400X , with the licence number:  78213 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WC0400X , with the licence number: RN150190 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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