1154519114 NPI number — JEANNE M HNILICKA PA-C

Table of content: JEANNE M HNILICKA PA-C (NPI 1154519114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154519114 NPI number — JEANNE M HNILICKA PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HNILICKA
Provider First Name:
JEANNE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RICKERT
Provider Other First Name:
JEANNE
Provider Other Middle Name:
HNILICKA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154519114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
521 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT STERLING
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62353-1378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-773-3963
Provider Business Mailing Address Fax Number:
217-773-3426

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1025 MAINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62301-4038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-222-6550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2007

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: 363A00000X , with the licence number:  085004330 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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