Provider Demographics
NPI:1699709279
Name:MAIN, RITA (HS1)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:MAIN
Suffix:
Gender:F
Credentials:HS1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMMANDING OFFICER US COAST GUARD SUPRTCEN ELIZABETH C
Mailing Address - Street 2:WEEKSVILLE RD BLDG 128
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:COMMANDING OFFICER US COAST GUARD SUPRTCEN ELIZABETH C
Practice Address - Street 2:WEEKSVILLE RD BLDG 128
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909
Practice Address - Country:US
Practice Address - Phone:252-335-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman