1063435543 NPI number — CATHY LIANE MSLP

Table of content: CATHY LIANE MSLP (NPI 1063435543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063435543 NPI number — CATHY LIANE MSLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIANE
Provider First Name:
CATHY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSLP
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:
1063435543
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 68
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NISSWA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56468-0068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-821-4923
Provider Business Mailing Address Fax Number:
218-961-4923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4820 COUNTY ROAD 77
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NISSWA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56468-2708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-821-4923
Provider Business Practice Location Address Fax Number:
218-961-4923
Provider Enumeration Date:
07/25/2006

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: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X , with the licence number: LP1535 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 111780 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 969050600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103209 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 111780 . This is a "BHP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6201430 . This is a "UBH MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 801312 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8H059LI . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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