1003831314 NPI number — MARY LYNN BARTEL MD

Table of content: DR. JILL HSIA M.D. (NPI 1346771359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003831314 NPI number — MARY LYNN BARTEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTEL
Provider First Name:
MARY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1003831314
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:
PO BOX 19070
Provider Second Line Business Mailing Address:
PREVEA HEALTH
Provider Business Mailing Address City Name:
GREEN BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54307-9070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-496-4700
Provider Business Mailing Address Fax Number:
920-496-4705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
835 S VAN BUREN ST
Provider Second Line Business Practice Location Address:
ROOM 1041
Provider Business Practice Location Address City Name:
GREEN BAY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54301-3526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-496-4700
Provider Business Practice Location Address Fax Number:
920-496-4705
Provider Enumeration Date:
07/13/2006

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: 208000000X , with the licence number:  39010 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 32511700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com