1538538095 NPI number — DR. KRISTINE SIESEL FAUVER ED.D.

Table of content: DR. KRISTINE SIESEL FAUVER ED.D. (NPI 1538538095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538538095 NPI number — DR. KRISTINE SIESEL FAUVER ED.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAUVER
Provider First Name:
KRISTINE
Provider Middle Name:
SIESEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
ED.D.
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:
1538538095
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13331 BISHOP RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWLING GREEN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-352-0354
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 NOLAN PARKWAY
Provider Second Line Business Practice Location Address:
NWOESC
Provider Business Practice Location Address City Name:
ARCHBOLD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
567-444-4808
Provider Business Practice Location Address Fax Number:
564-444-4804
Provider Enumeration Date:
09/15/2015

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: 103TS0200X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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