1205169273 NPI number — MS. TERESA ANN DOWLING FNP-BC, PMHNP

Table of content: MS. TERESA ANN DOWLING FNP-BC, PMHNP (NPI 1205169273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205169273 NPI number — MS. TERESA ANN DOWLING FNP-BC, PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOWLING
Provider First Name:
TERESA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC, PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROTH-DOWLING
Provider Other First Name:
TERESA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1205169273
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4972 COUNTY ROAD 38
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT CALHOUN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68023-5054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-641-8822
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4972 COUNTY ROAD 38
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT CALHOUN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68023-5054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-641-8822
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2009

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: 363LF0000X , with the licence number:  114254 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: G123175 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: A123175 , 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: 10027821400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".