1205008158 NPI number — MRS. ANDREA JOAN FRALE-KLOUDA RD MPH CCN LDN

Table of content: MRS. ANDREA JOAN FRALE-KLOUDA RD MPH CCN LDN (NPI 1205008158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205008158 NPI number — MRS. ANDREA JOAN FRALE-KLOUDA RD MPH CCN LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRALE-KLOUDA
Provider First Name:
ANDREA
Provider Middle Name:
JOAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD MPH CCN LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRALE
Provider Other First Name:
ANDREA
Provider Other Middle Name:
JOAN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205008158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
614 HICKORY STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60554-9302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-885-7907
Provider Business Mailing Address Fax Number:
630-466-1971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
614 HICKORY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUGAR GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60554-9302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-885-7907
Provider Business Practice Location Address Fax Number:
630-466-1971
Provider Enumeration Date:
04/01/2008

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: 133V00000X , 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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