1396967881 NPI number — MS. ANNETTE R MEYER AS

Table of content: MS. ANNETTE R MEYER AS (NPI 1396967881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396967881 NPI number — MS. ANNETTE R MEYER AS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEYER
Provider First Name:
ANNETTE
Provider Middle Name:
R
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
AS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WINGENBACH
Provider Other First Name:
ANNETTE
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
AS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396967881
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 13TH AVE W
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
DICKINSON
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58601-4879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-227-7520
Provider Business Mailing Address Fax Number:
701-227-7575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 13TH AVE W
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
DICKINSON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58601-4879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-227-7520
Provider Business Practice Location Address Fax Number:
701-227-7575
Provider Enumeration Date:
05/03/2007

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 54523 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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