1194704791 NPI number — MICHELE ANN GANSHIRT A.R.N.P.

Table of content: MICHELE ANN GANSHIRT A.R.N.P. (NPI 1194704791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194704791 NPI number — MICHELE ANN GANSHIRT A.R.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GANSHIRT
Provider First Name:
MICHELE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
A.R.N.P.
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:
1194704791
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 DELHI ST STE 3500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBUQUE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52001-6321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-557-3900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1690 ELM ST STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBUQUE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52001-3679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-690-2850
Provider Business Practice Location Address Fax Number:
563-557-8488
Provider Enumeration Date:
01/11/2006

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: 363LP0200X , with the licence number:  C074700 , 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: 9520 . This is a "MIDLAND'S CHOICE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: IA0113 . This is a "JOHN DEERE HEALTH PLAN" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 67374 . This is a "HAWK-I" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 11349 . This is a "DEAN HEALTH PLAN" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".