1720119993 NPI number — MRS. JANICE EUNICE HOUGHLAND M.S.

Table of content: MRS. JANICE EUNICE HOUGHLAND M.S. (NPI 1720119993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720119993 NPI number — MRS. JANICE EUNICE HOUGHLAND M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUGHLAND
Provider First Name:
JANICE
Provider Middle Name:
EUNICE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHEPHERD
Provider Other First Name:
JANICE
Provider Other Middle Name:
EUNICE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720119993
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:
1352 W 15TH LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APACHE JUNCTION
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85220-6227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-694-9587
Provider Business Mailing Address Fax Number:
623-321-1876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1352 W 15TH LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APACHE JUNCTION
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85220-6227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-694-9587
Provider Business Practice Location Address Fax Number:
623-321-1786
Provider Enumeration Date:
03/08/2007

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: 174400000X , with the licence number:  0771 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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