1568635035 NPI number — MRS. BRENDA SUE OEHLERICH PTA

Table of content: MRS. BRENDA SUE OEHLERICH PTA (NPI 1568635035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568635035 NPI number — MRS. BRENDA SUE OEHLERICH PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OEHLERICH
Provider First Name:
BRENDA
Provider Middle Name:
SUE
Provider Name Prefix Text:
MRS.
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:
1568635035
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 W BROAD ST
Provider Second Line Business Mailing Address:
PO BOX 122
Provider Business Mailing Address City Name:
NORTH ENGLISH
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-664-6134
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3661 ROCHESTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-341-8268
Provider Business Practice Location Address Fax Number:
319-341-6729
Provider Enumeration Date:
04/07/2008

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:  00740 , 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)