1518400043 NPI number — AMBIKA SELVAN PTA

Table of content: AMBIKA SELVAN PTA (NPI 1518400043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518400043 NPI number — AMBIKA SELVAN PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SELVAN
Provider First Name:
AMBIKA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PTA
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:
1518400043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2016
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 E-1
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:
785-856-7389
Provider Business Mailing Address Fax Number:
785-856-7392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 WAKARUSA DR
Provider Second Line Business Practice Location Address:
SUITE E-1
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:
785-856-7389
Provider Business Practice Location Address Fax Number:
785-856-7392
Provider Enumeration Date:
12/01/2016

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: 225200000X , with the licence number:  14-02943 , 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)

  • Identifier: 14-02943 . This is a "KANSAS STATE BOARD OF HEALING ARTS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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