1598352403 NPI number — MCKENZIE ALAYNE VRBA DENTAL ASSISTANT

Table of content: MCKENZIE ALAYNE VRBA DENTAL ASSISTANT (NPI 1598352403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598352403 NPI number — MCKENZIE ALAYNE VRBA DENTAL ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VRBA
Provider First Name:
MCKENZIE
Provider Middle Name:
ALAYNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DENTAL ASSISTANT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TATE
Provider Other First Name:
MCKENZIE
Provider Other Middle Name:
ALAYNE
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:
1598352403
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 LAURA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CERESCO
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68017-4131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
140-291-0347
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 LAURA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CERESCO
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68017-4131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
140-291-0347
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2020

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: 126800000X , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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