Provider Demographics
NPI:1932821980
Name:EARLY, IAN WALTER (HEALTH CARE PROVIDER)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:WALTER
Last Name:EARLY
Suffix:
Gender:M
Credentials:HEALTH CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 E AVENUE R APT 1-207
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-4590
Mailing Address - Country:US
Mailing Address - Phone:661-234-0915
Mailing Address - Fax:
Practice Address - Street 1:4160 E AVENUE R APT 1-207
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-4590
Practice Address - Country:US
Practice Address - Phone:661-234-0915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide