1891780839 NPI number — MRS. DEBRA LOU BAUNE MSW CSW PIP

Table of content: MRS. DEBRA LOU BAUNE MSW CSW PIP (NPI 1891780839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891780839 NPI number — MRS. DEBRA LOU BAUNE MSW CSW PIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAUNE
Provider First Name:
DEBRA
Provider Middle Name:
LOU
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW CSW PIP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROGERS
Provider Other First Name:
DEBRA
Provider Other Middle Name:
LOU
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891780839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1030
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57201-6030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-886-0123
Provider Business Mailing Address Fax Number:
605-886-5447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 19TH ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57201-2823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-886-0123
Provider Business Practice Location Address Fax Number:
605-886-5447
Provider Enumeration Date:
09/15/2005

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: 104100000X , with the licence number:  1962 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com