Basic Information
Provider Information
NPI: 1053695890
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VIORAL
FirstName: DAWN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 N HANOVER ST
Address2:  
City: CARLISLE
State: PA
PostalCode: 170132421
CountryCode: US
TelephoneNumber: 7172186670
FaxNumber: 7179604373
Practice Location
Address1: 100 N HANOVER ST
Address2:  
City: CARLISLE
State: PA
PostalCode: 170132421
CountryCode: US
TelephoneNumber: 7172186670
FaxNumber: 7179604373
Other Information
ProviderEnumerationDate: 09/28/2011
LastUpdateDate: 09/28/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174H00000X05-05-035PAY Other Service ProvidersHealth Educator 

No ID Information.


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