1245870369 NPI number — LAUREN PAIGE KLEIN APRN

Table of content: LAUREN PAIGE KLEIN APRN (NPI 1245870369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245870369 NPI number — LAUREN PAIGE KLEIN APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEIN
Provider First Name:
LAUREN
Provider Middle Name:
PAIGE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOWKER
Provider Other First Name:
LAUREN
Provider Other Middle Name:
PAIGE
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:
1245870369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
908 N HOWARD AVE STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND ISLAND
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68803-3529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-398-8900
Provider Business Mailing Address Fax Number:
308-398-8901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
908 N HOWARD AVE STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND ISLAND
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68803-3529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-398-8900
Provider Business Practice Location Address Fax Number:
308-398-8901
Provider Enumeration Date:
01/07/2020

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: 163W00000X , with the licence number:  75421 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: 113082 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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