1386698447 NPI number — MRS. SANDRA G REDSHAW MSW

Table of content: MRS. SANDRA G REDSHAW MSW (NPI 1386698447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386698447 NPI number — MRS. SANDRA G REDSHAW MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDSHAW
Provider First Name:
SANDRA
Provider Middle Name:
G
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
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:
1386698447
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 W BROADWAY
Provider Second Line Business Mailing Address:
SUITE 270
Provider Business Mailing Address City Name:
COUNCIL BLUFFS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51503-9045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-256-7511
Provider Business Mailing Address Fax Number:
712-256-9766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 W BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 270
Provider Business Practice Location Address City Name:
COUNCIL BLUFFS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51503-9045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-256-7511
Provider Business Practice Location Address Fax Number:
712-256-9766
Provider Enumeration Date:
05/20/2006

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: 1041C0700X , with the licence number:  01157 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 1509 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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