1639375272 NPI number — MRS. JILL OSLUND DASLER O.T. R.

Table of content: MRS. JILL OSLUND DASLER O.T. R. (NPI 1639375272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639375272 NPI number — MRS. JILL OSLUND DASLER O.T. R.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DASLER
Provider First Name:
JILL
Provider Middle Name:
OSLUND
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
O.T. R.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OSLUND
Provider Other First Name:
JILL
Provider Other Middle Name:
NADINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.T.R.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639375272
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
C3786 TWINS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STRATFORD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54484-9400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-687-4086
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 SAINT JOSEPH AVE
Provider Second Line Business Practice Location Address:
SAINT JOSEPHS HOSPITAL
Provider Business Practice Location Address City Name:
MARSHFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54449-1832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-387-7885
Provider Business Practice Location Address Fax Number:
715-389-4071
Provider Enumeration Date:
06/21/2007

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: 225X00000X , with the licence number:  1512-026 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com