1922056142 NPI number — KATHLEEN JESSICA SONLEITNER

Table of content: ROBERT J. WAIBEL DPT (NPI 1023271400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922056142 NPI number — KATHLEEN JESSICA SONLEITNER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHLEEN JESSICA SONLEITNER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1922056142
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 371
Provider Second Line Business Mailing Address:
514 N LAWLER ST
Provider Business Mailing Address City Name:
MITCHELL
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57301-2638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-995-6055
Provider Business Mailing Address Fax Number:
605-995-6033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
514 N LAWLER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MITCHELL
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57301-2638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-995-6055
Provider Business Practice Location Address Fax Number:
605-995-6033
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SONLEITNER
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
JESSICA
Authorized Official Title or Position:
OWNER SOLE PROPRIETOR
Authorized Official Telephone Number:
605-995-6055

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  892 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0006665 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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