1942863857 NPI number — MELANIE NOSKOWIAK

Table of content: MELANIE NOSKOWIAK (NPI 1942863857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942863857 NPI number — MELANIE NOSKOWIAK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOSKOWIAK
Provider First Name:
MELANIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NOSKOWIAK
Provider Other First Name:
MELANIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MAT, LAT, ATC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1942863857
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3750 COPPER OAK CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREEN BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54313-7585
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-562-5464
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12500 S APOPKA VINELAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32836-6723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-201-0914
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2019

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: 2255A2300X , with the licence number:  AL4951 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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