1801024724 NPI number — PENNILEE STEPHENS WEST CNM

Table of content: PENNILEE STEPHENS WEST CNM (NPI 1801024724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801024724 NPI number — PENNILEE STEPHENS WEST CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEST
Provider First Name:
PENNILEE
Provider Middle Name:
STEPHENS
Provider Name Prefix Text:
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:
1801024724
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4920 S 30TH ST
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68107-1590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-734-4110
Provider Business Mailing Address Fax Number:
402-991-5642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4920 S 30TH ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68107-1590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-734-4110
Provider Business Practice Location Address Fax Number:
402-991-5642
Provider Enumeration Date:
06/30/2009

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: 363LX0001X , with the licence number:  120039 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 120039 . This is a "NEBRASKA LICENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 69098 . This is a "NEBRASKA LICENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".