1790840882 NPI number — MRS. MARION LORRAINE TOEPKE RN FNP CNM

Table of content: MRS. MARION LORRAINE TOEPKE RN FNP CNM (NPI 1790840882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790840882 NPI number — MRS. MARION LORRAINE TOEPKE RN FNP CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOEPKE
Provider First Name:
MARION
Provider Middle Name:
LORRAINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN FNP CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOEPKE MCLEAN
Provider Other First Name:
MARION
Provider Other Middle Name:
LORRAINE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1790840882
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38574 DEXTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEXTER
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-937-3034
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3579 FRANKLIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97403-2356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-344-9411
Provider Business Practice Location Address Fax Number:
541-344-6519
Provider Enumeration Date:
12/27/2006

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:  0034202RN , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 0034202N1 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: 0034202N5 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1LC5381C , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".