1750765780 NPI number — LINDSI MARIA MCCRONE PNP

Table of content: MARQUE THOMAS KRIEBEL (NPI 1023877230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750765780 NPI number — LINDSI MARIA MCCRONE PNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCRONE
Provider First Name:
LINDSI
Provider Middle Name:
MARIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PNP
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:
1750765780
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 647
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPE MILLS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28348-0647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-483-7337
Provider Business Mailing Address Fax Number:
910-483-0648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14057 US HIGHWAY 17 N
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
HAMPSTEAD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28443-3770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-270-3673
Provider Business Practice Location Address Fax Number:
910-270-0529
Provider Enumeration Date:
07/20/2015

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: 363LP0200X , with the licence number:  5007786 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4710001 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 13446039 . This is a "PHCS/MULTIPLAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1750765780 . This is a "DOCTORS DIRECT" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5618180 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1750765780 . This is a "TRICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4571348 . This is a "COVENTRY NATIONAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: FH4002370 . This is a "FIRST CAROLINA CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1750765780 . This is a "HUMANA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 297174 . This is a "MEDCOST, LLC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 9692514 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1750765780 . This is a "HEALTHSMART" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1550788 . This is a "WELLPATH/COVENTRY NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1750765780 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19ECT . This is a "BCBS OF NORTH CAROLINA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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