1720613219 NPI number — DISEASE PREVENTION

Table of content: DALE MARIE SAMPSON NP (NPI 1306800925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720613219 NPI number — DISEASE PREVENTION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DISEASE PREVENTION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1720613219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 PRESTON EXECUTIVE DR STE 201-209
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27513-8485
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-345-0037
Provider Business Mailing Address Fax Number:
833-703-0206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 PRESTON EXECUTIVE DR STE 201-209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27513-8485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-345-0037
Provider Business Practice Location Address Fax Number:
833-703-0206
Provider Enumeration Date:
03/05/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VEERAMACHANENI
Authorized Official First Name:
APARNA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DIETITIAN
Authorized Official Telephone Number:
919-345-0037

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1720613219 . This is a "PRACTICE NPI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1770869497 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".