Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

NPI 1306904073

Individual provider · NPI 1306904073 Deactivated

This NPI was deactivated on September 3, 2026. The record is kept for reference and should not be used for billing or referrals.

NPI 1306904073 is listed in the national NPI registry.

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Record details

NPI number1306904073
Entity typeIndividual (Type 1)
NPI enumerated—
Last updated in NPPES—