1841540218 NPI number — MR. WILLIAM HENRY HARRISON MUTH JR. MDIV, MSN, ANP, RNBC

Table of content: MR. WILLIAM HENRY HARRISON MUTH JR. MDIV, MSN, ANP, RNBC (NPI 1841540218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841540218 NPI number — MR. WILLIAM HENRY HARRISON MUTH JR. MDIV, MSN, ANP, RNBC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUTH
Provider First Name:
WILLIAM
Provider Middle Name:
HENRY HARRISON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MDIV, MSN, ANP, RNBC
Provider Gender Code:
M

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:
1841540218
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1910 TOWNE CENTRE BLVD, UNIT 404
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-570-2515
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 IRVING STREET, NWDEPT
Provider Second Line Business Practice Location Address:
VETERANS AFFAIRS MEDICAL CENTE
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-745-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2012

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:  RN56590 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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