1053398610 NPI number — MS. CONNIE HALL STRONG APRN

Table of content: MS. CONNIE HALL STRONG APRN (NPI 1053398610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053398610 NPI number — MS. CONNIE HALL STRONG APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STRONG
Provider First Name:
CONNIE
Provider Middle Name:
HALL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STRONG
Provider Other First Name:
CONNIE
Provider Other Middle Name:
HARDY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053398610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2240 ADAMS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OGDEN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84401-1511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-393-5355
Provider Business Mailing Address Fax Number:
801-394-4609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 S STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84015-1043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-525-4900
Provider Business Practice Location Address Fax Number:
801-394-3693
Provider Enumeration Date:
12/26/2005

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: 364SP0809X , with the licence number:  2137244405 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 262079 . This is a "U002" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 942938348ST5 . This is a "U003" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 942938348 . This is a "U009" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 004662127 . This is a "RCAR" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 104472 . This is a "U005" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 107001407101 . This is a "U006" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 004662127 . This is a "ICAR" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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