1083742951 NPI number — KAYLA MARGARET WALDSCHMIDT MSE

Table of content: KAYLA MARGARET WALDSCHMIDT MSE (NPI 1083742951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083742951 NPI number — KAYLA MARGARET WALDSCHMIDT MSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALDSCHMIDT
Provider First Name:
KAYLA
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LACKAS
Provider Other First Name:
KAYLA
Provider Other Middle Name:
MARGARET
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083742951
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:
960 MARY LN
Provider Second Line Business Mailing Address:
APT. 5
Provider Business Mailing Address City Name:
LOMIRA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53048-9569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-360-7062
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 N CENTER ST
Provider Second Line Business Practice Location Address:
LOWER LEVEL-SUITE A
Provider Business Practice Location Address City Name:
BEAVER DAM
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53916-1166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-887-3172
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/01/2007

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: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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