1548541782 NPI number — THE OUTLET PLACE FOR WOMEN

Table of content: CHRISTINE MARIA JUST CNM (NPI 1851802037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548541782 NPI number — THE OUTLET PLACE FOR WOMEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE OUTLET PLACE FOR WOMEN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OUTLET PLACE FOR WOMEN THE
Provider Other Organization Name Type Code:
3
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:
1548541782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3401 BROADWAY ST # 16
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64111-2403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-984-4841
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1308 W TRUMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64050-3433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-984-4841
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
COULSON
Authorized Official First Name:
DETRONNE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
816-984-4841

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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