Healthcare Provider Details

I. General information

NPI: 1215129200
Provider Name (Legal Business Name): DFAS-CL/PMMF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 827 BOX 1000
FPO AE
09617
US

IV. Provider business mailing address

PSC 827 BOX 154
FPO AE
09617
US

V. Phone/Fax

Practice location:
  • Phone: 011390818116471
  • Fax:
Mailing address:
  • Phone: 011390818115023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number StateIL

VIII. Authorized Official

Name: CHRISTINE MOUER
Title or Position: STAFF NURSE
Credential: RN
Phone: 011390818116471