1437484748 NPI number — MRS. STACY CLARK NISHIBUN M.A.E, IECE

Table of content: MRS. STACY CLARK NISHIBUN M.A.E, IECE (NPI 1437484748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437484748 NPI number — MRS. STACY CLARK NISHIBUN M.A.E, IECE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NISHIBUN
Provider First Name:
STACY
Provider Middle Name:
CLARK
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.E, IECE
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:
1437484748
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 CHAPMAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42134-1647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-535-2928
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 CHAPMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42134-1647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-535-2928
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2009

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: 222Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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