1477713832 NPI number — MANDLE OZBUN PROFESSIONAL DEVELOPMENT, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477713832 NPI number — MANDLE OZBUN PROFESSIONAL DEVELOPMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANDLE OZBUN PROFESSIONAL DEVELOPMENT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1477713832
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 WAKARUSA DR
Provider Second Line Business Mailing Address:
SUITE E2
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66049-4722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-207-0944
Provider Business Mailing Address Fax Number:
785-856-0655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 WAKARUSA DR
Provider Second Line Business Practice Location Address:
SUITE E2
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66049-4722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-207-0944
Provider Business Practice Location Address Fax Number:
785-856-0655
Provider Enumeration Date:
06/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
OZBUN
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
MANDLE
Authorized Official Title or Position:
DIRECTOR/MEMBER
Authorized Official Telephone Number:
785-207-0944

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  1075 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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