1700040714 NPI number — MRS. DORIS ANN HABAS LPN PRIVATE DUTY NUR

Table of content: MRS. DORIS ANN HABAS LPN PRIVATE DUTY NUR (NPI 1700040714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700040714 NPI number — MRS. DORIS ANN HABAS LPN PRIVATE DUTY NUR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HABAS
Provider First Name:
DORIS
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN PRIVATE DUTY NUR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IVERSON
Provider Other First Name:
DORIS
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700040714
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30480 TODY ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-765-4814
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29250 HWY E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-765-4791
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2008

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: 164W00000X , with the licence number:  25473-031 , 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)

  • Identifier: 35059800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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