1710900261 NPI number — MS. PATRICIA ANN HASTINGS LCDP

Table of content: MS. PATRICIA ANN HASTINGS LCDP (NPI 1710900261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710900261 NPI number — MS. PATRICIA ANN HASTINGS LCDP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASTINGS
Provider First Name:
PATRICIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCDP
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:
1710900261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 WYNDHAM AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02908-3511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-521-6783
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
830 CHALKSTONE AVENUE
Provider Second Line Business Practice Location Address:
116F
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-457-3393
Provider Business Practice Location Address Fax Number:
401-457-3371
Provider Enumeration Date:
07/25/2006

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: 283Q00000X , with the licence number:  LCDP00347 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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