1548655350 NPI number — MRS. MARGARET LIANA EASTRIDGE MSN, AGCNS-BC, APRN

Table of content: MRS. MARGARET LIANA EASTRIDGE MSN, AGCNS-BC, APRN (NPI 1548655350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548655350 NPI number — MRS. MARGARET LIANA EASTRIDGE MSN, AGCNS-BC, APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EASTRIDGE
Provider First Name:
MARGARET
Provider Middle Name:
LIANA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, AGCNS-BC, APRN
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:
1548655350
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7703 FLOYD CURL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-450-9200
Provider Business Mailing Address Fax Number:
210-450-6013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7703 FLOYD CURL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-450-9200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2015

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: 364SA2100X , with the licence number:  AP127180 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SA2200X , with the licence number: AP127180 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 352825902 . This is a "CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 352825901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".