1699938043 NPI number — MRS. JANA L. BROTHERTON P.T.

Table of content: MRS. JANA L. BROTHERTON P.T. (NPI 1699938043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699938043 NPI number — MRS. JANA L. BROTHERTON P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROTHERTON
Provider First Name:
JANA
Provider Middle Name:
L.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCNULTY
Provider Other First Name:
JANA
Provider Other Middle Name:
LINN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699938043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1905 E. HUEBBE PARKWAY
Provider Second Line Business Mailing Address:
BELOIT HEALTH SYSTEM INC.
Provider Business Mailing Address City Name:
BELOIT
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53511-1842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-364-2200
Provider Business Mailing Address Fax Number:
608-363-7395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1650 LEE LN.
Provider Second Line Business Practice Location Address:
OCUPATIONAL HEALTH SPORTS & FAMILY MEDICINE CENTER
Provider Business Practice Location Address City Name:
BELOIT
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53511-3935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-362-0211
Provider Business Practice Location Address Fax Number:
608-364-4670
Provider Enumeration Date:
07/07/2008

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: 225100000X , with the licence number:  11815997 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 12237-24 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 070-019663 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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