1134393671 NPI number — EVELYN BRIGITTE SYFRETT CNM

Table of content: EVELYN BRIGITTE SYFRETT CNM (NPI 1134393671)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134393671 NPI number — EVELYN BRIGITTE SYFRETT CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SYFRETT
Provider First Name:
EVELYN
Provider Middle Name:
BRIGITTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
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:
1134393671
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 JEFFERSON AVE
Provider Second Line Business Mailing Address:
4TH FLOOR
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43604-7101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-251-2673
Provider Business Mailing Address Fax Number:
419-251-0916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3840 WOODLEY RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43606-1175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-475-0001
Provider Business Practice Location Address Fax Number:
419-475-2356
Provider Enumeration Date:
04/16/2008

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: 367A00000X , with the licence number:  NM01172 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0952929 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com