1902042591 NPI number — MR. ZIMBERLIST WARDELL HESTER SR. LPN

Table of content: MR. ZIMBERLIST WARDELL HESTER SR. LPN (NPI 1902042591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902042591 NPI number — MR. ZIMBERLIST WARDELL HESTER SR. LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HESTER
Provider First Name:
ZIMBERLIST
Provider Middle Name:
WARDELL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
LPN
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:
1902042591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HHD 168TH MMB
Provider Second Line Business Mailing Address:
UNIT 15021 BOX 20-B
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96218-5021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HHD 168TH MMB (AS)
Provider Second Line Business Practice Location Address:
UNIT NUMBER 15021 BOX 20-B
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96218-5021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
001825057644190
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/02/2009

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: 164W00000X , with the licence number:  LPN046331 , 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)





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