1306804075 NPI number — MS. LORELEI J NEIBURGER NP

Table of content: MS. LORELEI J NEIBURGER NP (NPI 1306804075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306804075 NPI number — MS. LORELEI J NEIBURGER NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEIBURGER
Provider First Name:
LORELEI
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KACZMARSKI
Provider Other First Name:
LORELEI
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306804075
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5055 E BROADWAY BLVD STE A-100
Provider Second Line Business Mailing Address:
ARIZONA COMMUNITY PHYSICIANS PC
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85711-3629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-327-0460
Provider Business Mailing Address Fax Number:
520-795-0225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5555 E 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85711-2415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-721-7886
Provider Business Practice Location Address Fax Number:
520-290-0596
Provider Enumeration Date:
05/03/2006

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: 363LA2200X , with the licence number:  049451 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 880436 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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