1528207248 NPI number — TIFFANY JEANNE STUELPNAGEL O.T.

Table of content: TIFFANY JEANNE STUELPNAGEL O.T. (NPI 1528207248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528207248 NPI number — TIFFANY JEANNE STUELPNAGEL O.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STUELPNAGEL
Provider First Name:
TIFFANY
Provider Middle Name:
JEANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.T.
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:
1528207248
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1284
Provider Second Line Business Mailing Address:
WEST HAVENS SUITE 103
Provider Business Mailing Address City Name:
MITCHELL
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57301-7284
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-995-6044
Provider Business Mailing Address Fax Number:
605-995-6044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 W HAVENS AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
MITCHELL
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57301-4366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-995-6044
Provider Business Practice Location Address Fax Number:
605-995-6044
Provider Enumeration Date:
02/19/2009

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: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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