1801889738 NPI number — MS. JUDY R. RAFSON FNP-BC

Table of content: MS. JUDY R. RAFSON FNP-BC (NPI 1801889738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801889738 NPI number — MS. JUDY R. RAFSON FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAFSON
Provider First Name:
JUDY
Provider Middle Name:
R.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
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:
1801889738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
628 E. 12TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-745-3191
Provider Business Mailing Address Fax Number:
252-745-7385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1530 NC HWY 306 SOUTH
Provider Second Line Business Practice Location Address:
OCCUPATIONAL HEALTH CLINICT, POTASHCORP-AURORA
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-322-8248
Provider Business Practice Location Address Fax Number:
252-322-8030
Provider Enumeration Date:
08/25/2005

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: 363L00000X , with the licence number:  77113 , 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: 02364 . This is a "BLUE CROSS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 73538 . This is a "BLUE CROSS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89-02364 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8973538 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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