1043281819 NPI number — JACQUALINE L DOHRMANN CRNA

Table of content: JACQUALINE L DOHRMANN CRNA (NPI 1043281819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043281819 NPI number — JACQUALINE L DOHRMANN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOHRMANN
Provider First Name:
JACQUALINE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1043281819
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:
25674 DEWEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDGEMONT
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57735-7004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-749-2308
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25674 DEWEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEMONT
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57735-7004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-749-2308
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2006

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:  560951 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: R032057-0492 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X , with the licence number: 20192.259 , 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: 100820 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: C01057 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: RNA-617 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: R27793 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 23817 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 84005U . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".