1306284898 NPI number — JANELL LYNN KIERSTEIN MS, CGC

Table of content: JANELL LYNN KIERSTEIN MS, CGC (NPI 1306284898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306284898 NPI number — JANELL LYNN KIERSTEIN MS, CGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIERSTEIN
Provider First Name:
JANELL
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, CGC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDERSON
Provider Other First Name:
JANELL
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, CGC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306284898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13123 E 16TH AVE
Provider Second Line Business Mailing Address:
BOX B153 GENETICS & METABOLISM
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80045-7106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-724-2344
Provider Business Mailing Address Fax Number:
720-777-7322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13123 E 16TH AVE
Provider Second Line Business Practice Location Address:
BOX B153 GENETICS & METABOLISM
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80045-7106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-724-2344
Provider Business Practice Location Address Fax Number:
720-777-7322
Provider Enumeration Date:
06/06/2013

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: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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