1679842330 NPI number — MS. MARTHA SCHAUB BORDEAUX RNC, PNP-BC

Table of content: MS. MARTHA SCHAUB BORDEAUX RNC, PNP-BC (NPI 1679842330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679842330 NPI number — MS. MARTHA SCHAUB BORDEAUX RNC, PNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORDEAUX
Provider First Name:
MARTHA
Provider Middle Name:
SCHAUB
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RNC, PNP-BC
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:
1679842330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2424 ERWIN RD
Provider Second Line Business Mailing Address:
SUITE 504, NEONATOLOGY
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27705-3824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-970-7341
Provider Business Mailing Address Fax Number:
919-681-6065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5524 HOSPITAL N
Provider Second Line Business Practice Location Address:
BOX 100500
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27710-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-970-7341
Provider Business Practice Location Address Fax Number:
919-681-6065
Provider Enumeration Date:
12/23/2011

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: 363LN0000X , with the licence number:  300319 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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