1003993320 NPI number — HOWARD SCHOOL DISTRICT 48-3

Table of content: MRS. ABIGAIL LYNN BROCK CRNP (NPI 1912339516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003993320 NPI number — HOWARD SCHOOL DISTRICT 48-3

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOWARD SCHOOL DISTRICT 48-3
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1003993320
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 N SECTION LINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOWARD
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57349-8709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-772-5515
Provider Business Mailing Address Fax Number:
605-772-5516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 N SECTION LINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOWARD
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57349-8709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-772-5515
Provider Business Practice Location Address Fax Number:
605-772-5516
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHERMAN
Authorized Official First Name:
MARCIA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BUSINESS OFFICIAL
Authorized Official Telephone Number:
605-772-5515

Provider Taxonomy Codes

  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5152430 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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