1386947950 NPI number — MRS. DAYNA ROSALIE BEADEL SMITH LPN

Table of content: MRS. DAYNA ROSALIE BEADEL SMITH LPN (NPI 1386947950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386947950 NPI number — MRS. DAYNA ROSALIE BEADEL SMITH LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEADEL SMITH
Provider First Name:
DAYNA
Provider Middle Name:
ROSALIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURDICK-SMITH
Provider Other First Name:
DAYNA
Provider Other Middle Name:
ROSALIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386947950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
799 N DEERLANE LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OTIS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97368-9677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-994-7689
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
799 N DEERLANE LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTIS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97368-9677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-994-7689
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2010

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: 164X00000X , with the licence number:  201030327LPN , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 164X00000X , with the licence number: 127745 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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