1740346188 NPI number — MRS. VERA PAULINE MANSFIELD CST, SA-C, CSFA

Table of content: MRS. VERA PAULINE MANSFIELD CST, SA-C, CSFA (NPI 1740346188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740346188 NPI number — MRS. VERA PAULINE MANSFIELD CST, SA-C, CSFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANSFIELD
Provider First Name:
VERA
Provider Middle Name:
PAULINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CST, SA-C, CSFA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMAS
Provider Other First Name:
VERA
Provider Other Middle Name:
PAULINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740346188
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2411 E RIVERSIDE DR APT H303
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAGLE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83616-7552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-724-2223
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2411 E RIVERSIDE DR APT H303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAGLE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83616-7552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-724-2223
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2006

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: 208600000X , with the licence number:  109984 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 246ZC0007X , with the licence number: 109984 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 246ZS0410X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 246ZC0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 06-158 . This is a "AM BOARD OF SURG ASSIST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 109984 . This is a "NBSTSA" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".