1619164936 NPI number — MARCIA KAY STRONG LPN,MA,CRC,CCM

Table of content: MARCIA KAY STRONG LPN,MA,CRC,CCM (NPI 1619164936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619164936 NPI number — MARCIA KAY STRONG LPN,MA,CRC,CCM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STRONG
Provider First Name:
MARCIA
Provider Middle Name:
KAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPN,MA,CRC,CCM
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:
1619164936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 S OAKMONT CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORKTOWN
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47396-9692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-759-5255
Provider Business Mailing Address Fax Number:
765-759-4882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 S OAKMONT CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORKTOWN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47396-9692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-759-5255
Provider Business Practice Location Address Fax Number:
765-759-4882
Provider Enumeration Date:
10/01/2007

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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