1750775110 NPI number — NICOLE C DUFF

Table of content: NICOLE C DUFF (NPI 1750775110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750775110 NPI number — NICOLE C DUFF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUFF
Provider First Name:
NICOLE
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1750775110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 S EDWIN C MOSES BLVD
Provider Second Line Business Mailing Address:
SAMARITAN BEHAVIORAL HEALTH, INC., 4TH FLOOR NW BLDG
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45417-3424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-734-8333
Provider Business Mailing Address Fax Number:
937-734-4343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SIX PATTERSON BLVD
Provider Second Line Business Practice Location Address:
SBHI- CAM
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-222-2400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2015

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: 101YP2500X , with the licence number:  E0022966 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com