1538153770 NPI number — MS. LEE ANN ROBERTS ABRASZEWSKI NP

Table of content: MS. LEE ANN ROBERTS ABRASZEWSKI NP (NPI 1538153770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538153770 NPI number — MS. LEE ANN ROBERTS ABRASZEWSKI NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABRASZEWSKI
Provider First Name:
LEE ANN
Provider Middle Name:
ROBERTS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FOSTER
Provider Other First Name:
LEEANN
Provider Other Middle Name:
ROBERTS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538153770
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
465 MEMORIAL DRIVE
Provider Second Line Business Mailing Address:
POCATELLO (ISU) FAMILY MEDICINE
Provider Business Mailing Address City Name:
POCATELLO
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83209-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-282-4700
Provider Business Mailing Address Fax Number:
208-282-4696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
POCATELLO (ISU) FAMILY MEDICINE
Provider Second Line Business Practice Location Address:
465 MEMORIAL DRIVE
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83209-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-282-4700
Provider Business Practice Location Address Fax Number:
208-282-4696
Provider Enumeration Date:
09/02/2005

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: 363LF0000X , with the licence number:  NP627A , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 806816900 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com