1912072018 NPI number — MRS. JILL ANN STEFFKE RN

Table of content: MRS. JILL ANN STEFFKE RN (NPI 1912072018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912072018 NPI number — MRS. JILL ANN STEFFKE RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEFFKE
Provider First Name:
JILL
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COOK
Provider Other First Name:
JILL
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912072018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4240 W WEIDMAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEIDMAN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48893-9717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-644-5408
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CENTRAL MICHIGAN UNIVERSITY HEALTH SERVICES
Provider Second Line Business Practice Location Address:
FOUST HALL 108
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48859-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-774-1748
Provider Business Practice Location Address Fax Number:
989-774-4335
Provider Enumeration Date:
11/22/2006

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: 163WC1400X , with the licence number:  4704168232 , registered in the state of MI ; 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