1801027362 NPI number — MRS. DIANNE STEUDEL BURDETTE RN, APN

Table of content: MRS. DIANNE STEUDEL BURDETTE RN, APN (NPI 1801027362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801027362 NPI number — MRS. DIANNE STEUDEL BURDETTE RN, APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURDETTE
Provider First Name:
DIANNE
Provider Middle Name:
STEUDEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, APN
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:
1801027362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 ROUTE 72 W
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
MANAHAWKIN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08050-2468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-978-9639
Provider Business Mailing Address Fax Number:
609-978-9685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 ROUTE 72 W
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
MANAHAWKIN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08050-2468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-978-9639
Provider Business Practice Location Address Fax Number:
609-978-9685
Provider Enumeration Date:
07/31/2009

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: 363LP0200X , with the licence number:  26NJ00171200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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