1881824852 NPI number — MISS MARJORIE YVONNE DERKSEN RN,CNS

Table of content: MISS MARJORIE YVONNE DERKSEN RN,CNS (NPI 1881824852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881824852 NPI number — MISS MARJORIE YVONNE DERKSEN RN,CNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DERKSEN
Provider First Name:
MARJORIE
Provider Middle Name:
YVONNE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
RN,CNS
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:
1881824852
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3080 ACKERMAN BLVD., #100
Provider Second Line Business Mailing Address:
DAYTON CHEST MEDICINE
Provider Business Mailing Address City Name:
KETTERING
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-396-1605
Provider Business Mailing Address Fax Number:
937-396-1607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3080 ACKERMAN BLVD., #100
Provider Second Line Business Practice Location Address:
DAYTON CHEST MEDICINE
Provider Business Practice Location Address City Name:
KETTERING
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-396-1605
Provider Business Practice Location Address Fax Number:
937-396-1607
Provider Enumeration Date:
07/23/2009

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: 364S00000X , with the licence number:  03233-NS , 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)





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