1720086630 NPI number — MS. SANDRA M. NUZUM CNM

Table of content: MS. SANDRA M. NUZUM CNM (NPI 1720086630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720086630 NPI number — MS. SANDRA M. NUZUM CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NUZUM
Provider First Name:
SANDRA
Provider Middle Name:
M.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CNM
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:
1720086630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4235 SECOR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43623-4231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-872-3201
Provider Business Mailing Address Fax Number:
419-872-3208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2751 BAY PARK DR.
Provider Second Line Business Practice Location Address:
SUITE #300
Provider Business Practice Location Address City Name:
OREGON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-690-7596
Provider Business Practice Location Address Fax Number:
419-697-6707
Provider Enumeration Date:
07/13/2005

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: 367A00000X , with the licence number:  APRNCNM07498 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 05225 . This is a "PARAMOUNT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 344428256 . This is a "FRONTPATH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 344428256 . This is a "BEECH STREET" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000320549 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 344428256 . This is a "HEALTHNET" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2454044 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 344428256088 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 344428256 . This is a "BEECHSTREET" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4584759 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4584768 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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