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

NPI 1811597404

Individual provider · NPI 1811597404 Deactivated

This NPI was deactivated on September 20, 2026. The record is kept for reference and should not be used for billing or referrals.

NPI 1811597404 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 number1811597404
Entity typeIndividual (Type 1)
NPI enumerated—
Last updated in NPPES—