1366764102 NPI number — MRS. TERESA YVONNE KLEEB L.M.T.

Table of content: MRS. TERESA YVONNE KLEEB L.M.T. (NPI 1366764102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366764102 NPI number — MRS. TERESA YVONNE KLEEB L.M.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEEB
Provider First Name:
TERESA
Provider Middle Name:
YVONNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.M.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROEKER
Provider Other First Name:
TERESA
Provider Other Middle Name:
YVONNE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366764102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
738 SOUTH C STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROKEN BOW
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68822-2031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-872-6853
Provider Business Mailing Address Fax Number:
308-872-6853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
738 S C ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROKEN BOW
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68822-2031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-872-6853
Provider Business Practice Location Address Fax Number:
308-872-6853
Provider Enumeration Date:
02/22/2010

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: 172M00000X , with the licence number:  1747 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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