1366463242 NPI number — CHRISTOPHER JON CHERNE RPH

Table of content: CHRISTOPHER JON CHERNE RPH (NPI 1366463242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366463242 NPI number — CHRISTOPHER JON CHERNE RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHERNE
Provider First Name:
CHRISTOPHER
Provider Middle Name:
JON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
M

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:
1366463242
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:
N3593 RANCH VIEW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APPLETON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54913-6914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-788-2426
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ZABLOCKI DEPARTMENT OF VETERAN AFFAIRS MEDICAL CTR
Provider Second Line Business Practice Location Address:
500 WEST NATIONAL AVE
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53295-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-384-2000
Provider Business Practice Location Address Fax Number:
414-389-4276
Provider Enumeration Date:
07/23/2006

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: 183500000X , with the licence number:  11691-040 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: 113912-9 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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