1316008139 NPI number — MRS. PATRICIA ANN MISKIMEN LISW

Table of content: MRS. PATRICIA ANN MISKIMEN LISW (NPI 1316008139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316008139 NPI number — MRS. PATRICIA ANN MISKIMEN LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MISKIMEN
Provider First Name:
PATRICIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316008139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5400 KIRKWOOD BLVD SW
Provider Second Line Business Mailing Address:
FOUR OAKS
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-364-0259
Provider Business Mailing Address Fax Number:
866-290-5565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 2ND AVE PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VINTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-472-4289
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2006

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: 104100000X , with the licence number:  00778 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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