1467692152 NPI number — MRS. CAROL A STEHLIK RD, LD, MBA, LMNT

Table of content: MRS. CAROL A STEHLIK RD, LD, MBA, LMNT (NPI 1467692152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467692152 NPI number — MRS. CAROL A STEHLIK RD, LD, MBA, LMNT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEHLIK
Provider First Name:
CAROL
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, LD, MBA, LMNT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAUGEN
Provider Other First Name:
CAROL
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467692152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 PERSHING AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHENANDOAH
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51601-0382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-246-1230
Provider Business Mailing Address Fax Number:
712-246-7357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 PERSHING AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHENANDOAH
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51601-0382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-246-1230
Provider Business Practice Location Address Fax Number:
712-246-7357
Provider Enumeration Date:
02/20/2009

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: 133NN1002X , with the licence number:  001809 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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