1619166782 NPI number — MRS. ALLISON LAUREN VANDERSAND RPH

Table of content: (NPI 1336754647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619166782 NPI number — MRS. ALLISON LAUREN VANDERSAND RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANDERSAND
Provider First Name:
ALLISON
Provider Middle Name:
LAUREN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
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:
1619166782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
583 BANGERT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUFFS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62621-8045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-754-3244
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
583 BANGERT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUFFS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62621-8045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-754-3244
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2007

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: 183500000X , with the licence number:  2006028511 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com