Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
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NPI 1184873879

Individual provider · NPI 1184873879 Deactivated

This NPI was deactivated on October 1, 2026. The record is kept for reference and should not be used for billing or referrals.

NPI 1184873879 is listed in the national NPI registry.

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Record details

NPI number1184873879
Entity typeIndividual (Type 1)
NPI enumerated—
Last updated in NPPES—