1497033930 NPI number — MRS. MELANIE KATHARINE MARTIN TSLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497033930 NPI number — MRS. MELANIE KATHARINE MARTIN TSLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
MELANIE
Provider Middle Name:
KATHARINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
TSLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LLOYD
Provider Other First Name:
MELANIE
Provider Other Middle Name:
KATHARINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497033930
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1110 CALL CREEK DR STE 4B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POCATELLO
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83201-3072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-233-4660
Provider Business Mailing Address Fax Number:
208-233-4262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 CALL CREEK DR STE 4B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83201-3072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-233-4660
Provider Business Practice Location Address Fax Number:
208-233-4262
Provider Enumeration Date:
08/02/2011

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: 235Z00000X , with the licence number:  TSLP-2126 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com