1457350811 NPI number — MRS. BARBARA ANN RODENBECK R.D., C.D.

Table of content: MRS. BARBARA ANN RODENBECK R.D., C.D. (NPI 1457350811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457350811 NPI number — MRS. BARBARA ANN RODENBECK R.D., C.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODENBECK
Provider First Name:
BARBARA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.D., C.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KERKHOF
Provider Other First Name:
BARBARA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457350811
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1622 MURRAY HILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEYMOUR
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47274-1133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-525-9029
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 N LINCOLN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47240-1327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-663-1341
Provider Business Practice Location Address Fax Number:
812-663-1125
Provider Enumeration Date:
07/19/2005

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: 133V00000X , with the licence number:  37000586A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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