Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
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NPI 1073583142

Individual provider · NPI 1073583142 Deactivated

This NPI was deactivated on November 5, 2026. The record is kept for reference and should not be used for billing or referrals.

NPI 1073583142 is listed in the national NPI registry.

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Record details

NPI number1073583142
Entity typeIndividual (Type 1)
NPI enumerated—
Last updated in NPPES—