1356590194 NPI number — DR. SU CAROLYN SKJERSAA LUKINBEAL RN, BS, D.MIN

Table of content: DR. SU CAROLYN SKJERSAA LUKINBEAL RN, BS, D.MIN (NPI 1356590194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356590194 NPI number — DR. SU CAROLYN SKJERSAA LUKINBEAL RN, BS, D.MIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKJERSAA LUKINBEAL
Provider First Name:
SU
Provider Middle Name:
CAROLYN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
RN, BS, D.MIN
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:
1356590194
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16356 SKYLINE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97701-6947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-317-8887
Provider Business Mailing Address Fax Number:
541-317-8887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
389 E. MAIN AVE.
Provider Second Line Business Practice Location Address:
LOWER BACK DOOR
Provider Business Practice Location Address City Name:
SISTERS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-317-8887
Provider Business Practice Location Address Fax Number:
541-317-8887
Provider Enumeration Date:
09/17/2008

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: 101YM0800X , with the licence number:  00002342RN , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WP0000X , with the licence number: 000023424RN , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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