1417901505 NPI number — MRS. MARGARET JABELLANA HASKEY RN

Table of content: MRS. MARGARET JABELLANA HASKEY RN (NPI 1417901505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417901505 NPI number — MRS. MARGARET JABELLANA HASKEY RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASKEY
Provider First Name:
MARGARET
Provider Middle Name:
JABELLANA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
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:
1417901505
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9336 SHERWOOD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53132-9131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-855-0636
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8801 W OKLAHOMA AVE
Provider Second Line Business Practice Location Address:
APT. 208
Provider Business Practice Location Address City Name:
WEST ALLIS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53227-4573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-543-4159
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2006

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: 163W00000X , 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: 38264000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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