1215076385 NPI number — MRS. SUSAN DARLENE OLER BOYD LPN

Table of content: MRS. SUSAN DARLENE OLER BOYD LPN (NPI 1215076385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215076385 NPI number — MRS. SUSAN DARLENE OLER BOYD LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLER BOYD
Provider First Name:
SUSAN
Provider Middle Name:
DARLENE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLER EDWARDS
Provider Other First Name:
SUSAN
Provider Other Middle Name:
DARLENE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215076385
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
LYSTER ARMY HEALTH CLINIC
Provider Second Line Business Mailing Address:
BLDG 301 ANDREWS AVE
Provider Business Mailing Address City Name:
FORT RUCKER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36362-5333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LYSTER ARMY HEALTH CLINIC
Provider Second Line Business Practice Location Address:
BLD 301 ANDREWS AVE
Provider Business Practice Location Address City Name:
FORT RUCKER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36362-5333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-255-7755
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2007

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: 164W00000X , with the licence number:  LPN047829 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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