1053541185 NPI number — STEPHANIE H G KASSELS APRN

Table of content: STEPHANIE H G KASSELS APRN (NPI 1053541185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053541185 NPI number — STEPHANIE H G KASSELS APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KASSELS
Provider First Name:
STEPHANIE
Provider Middle Name:
H G
Provider Name Prefix Text:
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:
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:
1053541185
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1546
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOLFEBORO
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03894-1546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-470-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
172 GOVERNOR WENTWORTH HWY
Provider Second Line Business Practice Location Address:
YMCA CAMP BELKNAP
Provider Business Practice Location Address City Name:
MIRROR LAKE
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-470-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2009

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: 363LF0000X , with the licence number:  067497-23 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 177623 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 26470781 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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