1922015866 NPI number — KAREN JAYNE O'BLOCK ANP

Table of content: KAREN JAYNE O'BLOCK ANP (NPI 1922015866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922015866 NPI number — KAREN JAYNE O'BLOCK ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'BLOCK
Provider First Name:
KAREN
Provider Middle Name:
JAYNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MERWIN
Provider Other First Name:
KAREN
Provider Other Middle Name:
JAYNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ANP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922015866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1640 COWLES ST.
Provider Second Line Business Mailing Address:
SUITE #1
Provider Business Mailing Address City Name:
FARIBANKS
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-452-4768
Provider Business Mailing Address Fax Number:
907-452-1009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1640 COWLES ST.
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
FARIBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-452-4768
Provider Business Practice Location Address Fax Number:
907-452-1009
Provider Enumeration Date:
08/02/2006

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:  244 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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