1871786178 NPI number — SHIRLEY SEEGER RD

Table of content: SHIRLEY SEEGER RD (NPI 1871786178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871786178 NPI number — SHIRLEY SEEGER RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEEGER
Provider First Name:
SHIRLEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLARK
Provider Other First Name:
SHIRLEY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871786178
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2613 NONOHE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAHIAWA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96786-2842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-621-2826
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
98-1005 MOANALUA RD
Provider Second Line Business Practice Location Address:
STE. 420, CKD SERVICES OF PEARLRIDGE
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-4777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-440-4800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2007

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: 133VN1005X , with the licence number:  726692 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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