1508972795 NPI number — MS. KAREN M STILLE PT

Table of content: MS. KAREN M STILLE PT (NPI 1508972795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508972795 NPI number — MS. KAREN M STILLE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STILLE
Provider First Name:
KAREN
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KELLEY
Provider Other First Name:
KAREN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508972795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1651 N 86TH ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68505-3719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-484-7117
Provider Business Mailing Address Fax Number:
402-484-7118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1409 SILVER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68003-1845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-944-3505
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2006

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: 225100000X , with the licence number:  784 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 650017043 . This is a "MEDICARE (RAILROAD)" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 39697 . This is a "BCBS OF NEBRASKA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".