1851324321 NPI number — MRS. ROBIN ELAINE-DRAKE KACZANOWSKI APRN-BC, FNP

Table of content: MRS. ROBIN ELAINE-DRAKE KACZANOWSKI APRN-BC, FNP (NPI 1851324321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851324321 NPI number — MRS. ROBIN ELAINE-DRAKE KACZANOWSKI APRN-BC, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KACZANOWSKI
Provider First Name:
ROBIN
Provider Middle Name:
ELAINE-DRAKE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN-BC, FNP
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:
1851324321
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:
2223 N CHARLES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAGINAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48602-5007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-497-2500
Provider Business Mailing Address Fax Number:
989-791-2423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 WEISS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48602-5251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-497-2500
Provider Business Practice Location Address Fax Number:
989-791-2423
Provider Enumeration Date:
07/08/2006

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: 363LF0000X , with the licence number:  4704185491 , registered in the state of MI ; 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