1649292772 NPI number — SHERRI CLAIRE SZCZEPANSKI APNP

Table of content: SHERRI CLAIRE SZCZEPANSKI APNP (NPI 1649292772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649292772 NPI number — SHERRI CLAIRE SZCZEPANSKI APNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SZCZEPANSKI
Provider First Name:
SHERRI
Provider Middle Name:
CLAIRE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APNP
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:
1649292772
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1715 DOUSMAN STREET
Provider Second Line Business Mailing Address:
PREVEA HEALTH
Provider Business Mailing Address City Name:
GREEN BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-496-4700
Provider Business Mailing Address Fax Number:
920-272-1011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1727 SHAWANO AVE.
Provider Second Line Business Practice Location Address:
PREVEA HEALTH
Provider Business Practice Location Address City Name:
GREEN BAY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54307-3008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-272-1010
Provider Business Practice Location Address Fax Number:
920-272-1011
Provider Enumeration Date:
07/25/2006

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: 163W00000X , with the licence number:  116807 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 2805 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 2805 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 36000600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".