1013294545 NPI number — HANNAH GAVESKE ATC

Table of content: HANNAH GAVESKE ATC (NPI 1013294545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013294545 NPI number — HANNAH GAVESKE ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAVESKE
Provider First Name:
HANNAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ATC
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:
1013294545
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
630 9TH ST N
Provider Second Line Business Mailing Address:
APT 202
Provider Business Mailing Address City Name:
LA CROSSE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54601-3447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 MONTGOMERY ST
Provider Second Line Business Practice Location Address:
REHABILITATION SERVICES
Provider Business Practice Location Address City Name:
DECORAH
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52101-2325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-382-2911
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2011

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:  000994 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2255A2300X , with the licence number: 1150-039 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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