1932134442 NPI number — MS. TINA R. DODSON L.P.N. / L.P.C.

Table of content: MS. TINA R. DODSON L.P.N. / L.P.C. (NPI 1932134442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932134442 NPI number — MS. TINA R. DODSON L.P.N. / L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DODSON
Provider First Name:
TINA
Provider Middle Name:
R.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.P.N. / L.P.C.
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:
1932134442
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9565
Provider Second Line Business Mailing Address:
POB 9565 / 5813 LAUREL AVE / T.DODSON, LPN / LPC
Provider Business Mailing Address City Name:
RAYTOWN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64133-0365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-550-9549
Provider Business Mailing Address Fax Number:
816-313-6907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5813 LAUREL AVE
Provider Second Line Business Practice Location Address:
C/O POB 9565 / 5813 LAUREL AVE / T.DODSON, LPN / LPC
Provider Business Practice Location Address City Name:
RAYTOWN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64133-3260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-550-9549
Provider Business Practice Location Address Fax Number:
816-313-6907
Provider Enumeration Date:
07/12/2006

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: 101YP2500X , with the licence number:  2001004045 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 164W00000X , with the licence number: 032173 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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