1528236379 NPI number — MRS. ALISON LESLEY RANK GWINN CPNP

Table of content: MRS. ALISON LESLEY RANK GWINN CPNP (NPI 1528236379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528236379 NPI number — MRS. ALISON LESLEY RANK GWINN CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GWINN
Provider First Name:
ALISON
Provider Middle Name:
LESLEY RANK
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPNP
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:
1528236379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 24TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LEE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23801-1716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-734-9125
Provider Business Mailing Address Fax Number:
804-734-9011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 24TH ST
Provider Second Line Business Practice Location Address:
USAMEDDAC KAHC
Provider Business Practice Location Address City Name:
FORT LEE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23801-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-734-9125
Provider Business Practice Location Address Fax Number:
804-734-9011
Provider Enumeration Date:
02/14/2008

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: 363LP0200X , with the licence number:  0024167333 , registered in the state of VA ; 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