1790107407 NPI number — TINA MARIE DORNER RN

Table of content: TINA MARIE DORNER RN (NPI 1790107407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790107407 NPI number — TINA MARIE DORNER RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DORNER
Provider First Name:
TINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DORNER
Provider Other First Name:
TINA
Provider Other Middle Name:
MYERS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1790107407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
USA MEDDAC BAVARIA
Provider Second Line Business Mailing Address:
CMR 411, BLDG 700, ROSE BARRACKS
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
499662834719
Provider Business Mailing Address Fax Number:
499662834721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CMR 415 BOX 3436
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09114-0035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
499641836584
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/15/2014

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: 163WP2201X , with the licence number:  RN150467 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: VADOO . This is a "UPIN" identifier . This identifiers is of the category "OTHER".




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