1437164399 NPI number — ASELO V LAYAWEN MD

Table of content: ASELO V LAYAWEN MD (NPI 1437164399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437164399 NPI number — ASELO V LAYAWEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAYAWEN
Provider First Name:
ASELO
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1437164399
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6001
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARGO
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58108-6001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-364-3300
Provider Business Mailing Address Fax Number:
701-364-8906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 32ND AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58103-6132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-364-8000
Provider Business Practice Location Address Fax Number:
701-364-8078
Provider Enumeration Date:
07/29/2006

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: 207R00000X , with the licence number:  9464 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HP42582 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12492 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26744 . This is a "BCBS ND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2433967 . This is a "AMERICAS PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0408684 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1034901 . This is a "PREFERREDONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 96G36LA . This is a "MN BCBS" identifier . This identifiers is of the category "OTHER".




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