1023061181 NPI number — HEATHER J NASKER CRNA, MSN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023061181 NPI number — HEATHER J NASKER CRNA, MSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NASKER
Provider First Name:
HEATHER
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA, MSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STUMBO
Provider Other First Name:
HEATHER
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA, MSN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023061181
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
746 JARBIDGE AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETON
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83644-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-412-8177
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3235 N TOWERBRIDGE WAY
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83646-5721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-412-8177
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2006

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: 367500000X , with the licence number:  20516.769 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 200560042CRNA , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 4788A , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: RNA-364 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 273226 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 312042 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 10024962200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 118252800 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807334300 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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