1235341082 NPI number — MRS. MARY BETH HAMVAI MS, RD, LD

Table of content: MRS. MARY BETH HAMVAI MS, RD, LD (NPI 1235341082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235341082 NPI number — MRS. MARY BETH HAMVAI MS, RD, LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMVAI
Provider First Name:
MARY
Provider Middle Name:
BETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, LD
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:
1235341082
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11567 57TH ST. CIR. E.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARRISH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-932-4412
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BLAKE MEDICAL CENTER
Provider Second Line Business Practice Location Address:
2020 59TH ST. W.
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-798-6135
Provider Business Practice Location Address Fax Number:
941-798-6023
Provider Enumeration Date:
05/04/2007

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: 133V00000X , with the licence number:  1828 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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