1003860099 NPI number — MRS. CAROLEE MAE HINTERMAN P.T.

Table of content: MRS. CAROLEE MAE HINTERMAN P.T. (NPI 1003860099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003860099 NPI number — MRS. CAROLEE MAE HINTERMAN P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HINTERMAN
Provider First Name:
CAROLEE
Provider Middle Name:
MAE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WENZLICK
Provider Other First Name:
CAROLEE
Provider Other Middle Name:
MAE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003860099
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:
2574 N ASHWOOD PASS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48642-7878
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-430-9457
Provider Business Mailing Address Fax Number:
989-835-9518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2574 N ASHWOOD PASS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48642-7878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-430-9457
Provider Business Practice Location Address Fax Number:
989-835-9518
Provider Enumeration Date:
05/22/2006

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: 208100000X , with the licence number:  5501003000 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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