1285934224 NPI number — LISA RENEE KUZMAN CLINICAL SOCIAL WORK

Table of content: LISA RENEE KUZMAN CLINICAL SOCIAL WORK (NPI 1285934224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285934224 NPI number — LISA RENEE KUZMAN CLINICAL SOCIAL WORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUZMAN
Provider First Name:
LISA
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CLINICAL SOCIAL WORK
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TATGE
Provider Other First Name:
LISA
Provider Other Middle Name:
RENEE
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:
1285934224
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MONUMENT HEALTH HOME PLUS, LLC
Provider Second Line Business Mailing Address:
PO BOX 860013
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55486-0013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MONUMENT HEALTH HOME PLUS, LLC
Provider Second Line Business Practice Location Address:
224 ELK STREET
Provider Business Practice Location Address City Name:
RAPID CITY
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-755-7710
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/25/2010

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: 104100000X , with the licence number:  006892 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: CSW-PIP6277 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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