1902828031 NPI number — MS. GAIL RENEE KNECHT LOY AU.,D.

Table of content: (NPI 1124175021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902828031 NPI number — MS. GAIL RENEE KNECHT LOY AU.,D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNECHT LOY
Provider First Name:
GAIL
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
AU.,D.
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:
1902828031
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2606 E 350 S
Provider Second Line Business Mailing Address:
SUITE 9-19
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47909-9184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-474-4544
Provider Business Mailing Address Fax Number:
765-474-1122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2606 E 350 S
Provider Second Line Business Practice Location Address:
SUITE 9-19
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47909-9184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-474-4544
Provider Business Practice Location Address Fax Number:
765-474-1122
Provider Enumeration Date:
07/25/2006

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: 231H00000X , with the licence number:  23001969A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000370115 . This is a "ANTHEM PIN NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com