1497713077 NPI number — MRS. DANA A D BISCHOFF MA CSADC

Table of content: MRS. DANA A D BISCHOFF MA CSADC (NPI 1497713077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497713077 NPI number — MRS. DANA A D BISCHOFF MA CSADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BISCHOFF
Provider First Name:
DANA
Provider Middle Name:
A D
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA CSADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DRAPEAU
Provider Other First Name:
DANA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497713077
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:
100 N MAIN
Provider Second Line Business Mailing Address:
SUITE L100
Provider Business Mailing Address City Name:
EAST PEORIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-694-6462
Provider Business Mailing Address Fax Number:
309-694-7812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 N MAIN
Provider Second Line Business Practice Location Address:
SUITE L100
Provider Business Practice Location Address City Name:
EAST PEORIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-694-6462
Provider Business Practice Location Address Fax Number:
309-694-7812
Provider Enumeration Date:
05/03/2006

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: 101YA0400X , with the licence number:  23583 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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