1659334233 NPI number — LAURA ELIZABETH KENTER M.S., A.T.C.

Table of content: LAURA ELIZABETH KENTER M.S., A.T.C. (NPI 1659334233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659334233 NPI number — LAURA ELIZABETH KENTER M.S., A.T.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENTER
Provider First Name:
LAURA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., A.T.C.
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:
1659334233
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:
1807 CONTINENTAL AVE
Provider Second Line Business Mailing Address:
APT 202
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60563-4014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-803-5576
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5700 COLLEGE RD
Provider Second Line Business Practice Location Address:
ATHLETIC TRAINING
Provider Business Practice Location Address City Name:
LISLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60532-2851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-829-6152
Provider Business Practice Location Address Fax Number:
630-960-0899
Provider Enumeration Date:
04/06/2006

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: 2255A2300X , 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)





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