1598951899 NPI number — WAUBAY SCHOOL DISTRICT 18 3

Table of content: MRS. DANA ELIZABETH ALLEN FNP,CRNP (NPI 1073836482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598951899 NPI number — WAUBAY SCHOOL DISTRICT 18 3

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAUBAY SCHOOL DISTRICT 18 3
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:
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:
1598951899
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 W SCHOOL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUBAY
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57273-2134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-947-4529
Provider Business Mailing Address Fax Number:
605-947-4243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 W SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUBAY
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57273-2134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-947-4529
Provider Business Practice Location Address Fax Number:
605-947-4243
Provider Enumeration Date:
09/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOIK
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
605-947-4529

Provider Taxonomy Codes

  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5150460 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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