1013156876 NPI number — AMANDA LYNN SCHARNINGHAUSEN PTA

Table of content: AMANDA LYNN SCHARNINGHAUSEN PTA (NPI 1013156876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013156876 NPI number — AMANDA LYNN SCHARNINGHAUSEN PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHARNINGHAUSEN
Provider First Name:
AMANDA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013156876
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3706 CLAIRMONT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RACINE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53406-5344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-598-9516
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3415 SHERIDAN ROAD
Provider Second Line Business Practice Location Address:
WOODSTOCK
Provider Business Practice Location Address City Name:
KENOSHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53140-1924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-657-6175
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  1498-019 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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