1932304516 NPI number — MRS. NETTIE LOUISE TEAQUE FOSTER CARE PARENT

Table of content: MRS. NETTIE LOUISE TEAQUE FOSTER CARE PARENT (NPI 1932304516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932304516 NPI number — MRS. NETTIE LOUISE TEAQUE FOSTER CARE PARENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEAQUE
Provider First Name:
NETTIE
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FOSTER CARE PARENT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TEAQUE
Provider Other First Name:
NETTIE
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
FOSTER CARE PARENT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1932304516
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:
RT 1 BOX 856
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPERRY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-288-6231
Provider Business Mailing Address Fax Number:
918-288-6231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RT 1 BOX 856
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPERRY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-288-6231
Provider Business Practice Location Address Fax Number:
918-288-6231
Provider Enumeration Date:
06/15/2007

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: 177F00000X , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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