1770815839 NPI number — ALETHA DESIREE MARIE WEBB ANP-BC

Table of content: ALETHA DESIREE MARIE WEBB ANP-BC (NPI 1770815839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770815839 NPI number — ALETHA DESIREE MARIE WEBB ANP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBB
Provider First Name:
ALETHA
Provider Middle Name:
DESIREE MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ANP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MATSIS
Provider Other First Name:
ALETHA
Provider Other Middle Name:
DESIREE MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ANP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770815839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5730 BOWDEN ROAD
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-419-0273
Provider Business Mailing Address Fax Number:
904-419-4981

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 2ND AVE
Provider Second Line Business Practice Location Address:
SUITE 450
Provider Business Practice Location Address City Name:
NEEDHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02494-2820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-363-4752
Provider Business Practice Location Address Fax Number:
781-444-9588
Provider Enumeration Date:
01/31/2010

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: 363LA2200X , with the licence number:  APRN9323571 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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