1780862656 NPI number — MRS. PAULETTE RYSANEK LPTA

Table of content: MRS. PAULETTE RYSANEK LPTA (NPI 1780862656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780862656 NPI number — MRS. PAULETTE RYSANEK LPTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYSANEK
Provider First Name:
PAULETTE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOLSTER
Provider Other First Name:
PAULETTE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPTA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780862656
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7227 LAND O LAKES BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAND O LAKES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34638-2826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-794-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7227 LAND O LAKES BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAND O LAKES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34638-2826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-794-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2008

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: 225200000X , with the licence number:  QB01075 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X , with the licence number: 20276 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225200000X , with the licence number: 000616-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: 004316-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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