1528176617 NPI number — DENISE A SUEDKAMP PA-C

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 1528176617 NPI number — DENISE A SUEDKAMP PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUEDKAMP
Provider First Name:
DENISE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LUNA
Provider Other First Name:
DENISE
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528176617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1213 GARFIELD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLAN
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51537-2057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-755-5161
Provider Business Mailing Address Fax Number:
712-755-4312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 CHATBURN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLAN
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51537-2009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-755-5130
Provider Business Practice Location Address Fax Number:
712-755-4446
Provider Enumeration Date:
08/28/2006

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: 363A00000X , with the licence number:  1244 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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