1154418598 NPI number — MS. NANCY L FINCHAM M.P.T.

Table of content: MS. NANCY L FINCHAM M.P.T. (NPI 1154418598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154418598 NPI number — MS. NANCY L FINCHAM M.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FINCHAM
Provider First Name:
NANCY
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.P.T.
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:
1154418598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2431 CORAL CT STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORALVILLE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-545-4104
Provider Business Mailing Address Fax Number:
319-545-4105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2431 CORAL CT STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORALVILLE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-545-4104
Provider Business Practice Location Address Fax Number:
319-545-4105
Provider Enumeration Date:
10/06/2006

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: 225100000X , with the licence number:  004117 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1154418598 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".