1942611553 NPI number — DR. DEVANNI LYNNE PEARSON D.C.

Table of content: DR. DEVANNI LYNNE PEARSON D.C. (NPI 1942611553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942611553 NPI number — DR. DEVANNI LYNNE PEARSON D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEARSON
Provider First Name:
DEVANNI
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARTRIDGE
Provider Other First Name:
DEVANNI
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942611553
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1310 BURDICK EXPY E
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
MINOT
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58701-4912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-852-5230
Provider Business Mailing Address Fax Number:
701-540-0232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 BURDICK EXPY E
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MINOT
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58701-4912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-852-5230
Provider Business Practice Location Address Fax Number:
701-540-0232
Provider Enumeration Date:
05/16/2014

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: 111N00000X , with the licence number:  969 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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