1245280254 NPI number — MRS. NADA DANIELLE HIEB PT

Table of content: MRS. NADA DANIELLE HIEB PT (NPI 1245280254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245280254 NPI number — MRS. NADA DANIELLE HIEB PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HIEB
Provider First Name:
NADA
Provider Middle Name:
DANIELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PHINNEY
Provider Other First Name:
NADA
Provider Other Middle Name:
DANIELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1245280254
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4405 ASHLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUSAU
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-847-2000
Provider Business Mailing Address Fax Number:
715-847-2046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 WESTHILL DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WAUSAU
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54401-4705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-847-2827
Provider Business Practice Location Address Fax Number:
715-847-2046
Provider Enumeration Date:
05/11/2006

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: 225100000X , with the licence number:  9775024 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 36153700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 78778 . This is a "SECURITY HEALTH" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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