1154365633 NPI number — JAN E OLSON-ZERINGUE CRNP

Table of content: JAN E OLSON-ZERINGUE CRNP (NPI 1154365633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154365633 NPI number — JAN E OLSON-ZERINGUE CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLSON-ZERINGUE
Provider First Name:
JAN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
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:
1154365633
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
930 FRANKLIN ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35801-4312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-539-4080
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
930 FRANKLIN ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-4312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-539-4080
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2006

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: 363L00000X , with the licence number:  1 051725 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 510-49756 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 510-49754 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1 051725 . This is a "BOARD OF NURSING" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 113305 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 510-49757 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 113308 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 510-49755 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 113301 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113299 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113303 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515-99965 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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