1508097510 NPI number — MISS CHELSEA LYNN SACKETT M.T.

Table of content: MISS CHELSEA LYNN SACKETT M.T. (NPI 1508097510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508097510 NPI number — MISS CHELSEA LYNN SACKETT M.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SACKETT
Provider First Name:
CHELSEA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.T.
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:
1508097510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
403 S 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YOUNGWOOD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15697-5100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-925-9220
Provider Business Mailing Address Fax Number:
724-925-3742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
403 S 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YOUNGWOOD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15697-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-925-9220
Provider Business Practice Location Address Fax Number:
724-925-3742
Provider Enumeration Date:
08/07/2009

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: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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