1205168069 NPI number — JUSTINE RUTH SCHLEICHER CNM

Table of content: JUSTINE RUTH SCHLEICHER CNM (NPI 1205168069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205168069 NPI number — JUSTINE RUTH SCHLEICHER CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHLEICHER
Provider First Name:
JUSTINE
Provider Middle Name:
RUTH
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:
1205168069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2501 WESTOWN PKWY STE 1101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50266-1438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-267-8300
Provider Business Mailing Address Fax Number:
515-309-6014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 WESTOWN PKWY STE 1101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WDM
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50266-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-267-8300
Provider Business Practice Location Address Fax Number:
515-267-8872
Provider Enumeration Date:
02/04/2010

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:  13272 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1205168069 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".