1255618971 NPI number — MR. ANTHONY CLIFFORD FYFFE-WOOTEN BSN, RN

Table of content: MR. ANTHONY CLIFFORD FYFFE-WOOTEN BSN, RN (NPI 1255618971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255618971 NPI number — MR. ANTHONY CLIFFORD FYFFE-WOOTEN BSN, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FYFFE-WOOTEN
Provider First Name:
ANTHONY
Provider Middle Name:
CLIFFORD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
BSN, RN
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:
1255618971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
92 WYNDEMERE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45005-2465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-985-2761
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
142 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45005-1628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-998-6693
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/09/2011

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: 163W00000X , with the licence number:  RN-374937 , 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)





Copyright © 2007-2024 www.npivalidator.com