1891218814 NPI number — MRS. RAEL OKOTH ECKENROED FNP-C

Table of content: MRS. RAEL OKOTH ECKENROED FNP-C (NPI 1891218814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891218814 NPI number — MRS. RAEL OKOTH ECKENROED FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ECKENROED
Provider First Name:
RAEL
Provider Middle Name:
OKOTH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OKOTH
Provider Other First Name:
RAEL
Provider Other Middle Name:
ATIENO
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891218814
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 SALEM DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EULESS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76039-3822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
18175002365
Provider Business Mailing Address Fax Number:
817-355-0396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
808 S BALLARD AVE STE 140B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYLIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75098-4228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-878-9934
Provider Business Practice Location Address Fax Number:
972-476-0904
Provider Enumeration Date:
07/21/2017

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: 363LF0000X , with the licence number:  134903 , 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)





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