Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

NPI 1710018114

Individual provider · NPI 1710018114 Deactivated

This NPI was deactivated on September 17, 2026. The record is kept for reference and should not be used for billing or referrals.

NPI 1710018114 is listed in the national NPI registry.

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Record details

NPI number1710018114
Entity typeIndividual (Type 1)
NPI enumerated—
Last updated in NPPES—