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

NPI 1477106128

Individual provider · NPI 1477106128 Deactivated

This NPI was deactivated on September 24, 2026. The record is kept for reference and should not be used for billing or referrals.

NPI 1477106128 is listed in the national NPI registry.

Claim this listing Report a problem Suggest an edit

Practice location Incomplete address

The federal record is missing the street or ZIP for this provider.

No coordinates on file. Search this address in Google Maps

Specialties & licences

Record details

NPI number1477106128
Entity typeIndividual (Type 1)
NPI enumerated—
Last updated in NPPES—