1083867477 NPI number — DR. LORI MARIE PIERQUET PSYD

Table of content: DR. LORI MARIE PIERQUET PSYD (NPI 1083867477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083867477 NPI number — DR. LORI MARIE PIERQUET PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIERQUET
Provider First Name:
LORI
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
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:
1083867477
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
375 EXECUTIVE SUITES
Provider Second Line Business Mailing Address:
CITY CENTER
Provider Business Mailing Address City Name:
OSHKOSH
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-216-3746
Provider Business Mailing Address Fax Number:
920-235-5028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
375 C EXECUTIVE SUITES
Provider Second Line Business Practice Location Address:
CITY CENTER
Provider Business Practice Location Address City Name:
OSHKOSH
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-216-3746
Provider Business Practice Location Address Fax Number:
920-235-5028
Provider Enumeration Date:
10/29/2008

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: 103TC0700X , with the licence number:  2146057 , 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)

  • Identifier: 39125200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".