1386695435 NPI number — MS. REBECCA C COGWELL ANDERSON PHD

Table of content: MS. REBECCA C COGWELL ANDERSON PHD (NPI 1386695435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386695435 NPI number — MS. REBECCA C COGWELL ANDERSON PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COGWELL ANDERSON
Provider First Name:
REBECCA
Provider Middle Name:
C
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1386695435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
959 N MAYFAIR RD
Provider Second Line Business Mailing Address:
MCW PAIN MANAGEMENT CLINIC
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53226-3465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-955-7601
Provider Business Mailing Address Fax Number:
414-955-6020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
959 N MAYFAIR RD
Provider Second Line Business Practice Location Address:
MCW PAIN MANAGEMENT CLINIC
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-3465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-955-7601
Provider Business Practice Location Address Fax Number:
414-955-6020
Provider Enumeration Date:
05/13/2006

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: 103T00000X , with the licence number:  1542 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1386695435 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002000108D . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".




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