1104183177 NPI number — MRS. CAROLYN SCHMIDT PENNING OTR

Table of content: MRS. CAROLYN SCHMIDT PENNING OTR (NPI 1104183177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104183177 NPI number — MRS. CAROLYN SCHMIDT PENNING OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENNING
Provider First Name:
CAROLYN
Provider Middle Name:
SCHMIDT
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHMIDT
Provider Other First Name:
CAROLYN
Provider Other Middle Name:
MARGARET
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104183177
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2132 HOFFMAN RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANKATO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-386-7401
Provider Business Mailing Address Fax Number:
507-386-1379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2132 HOFFMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANKATO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-386-7401
Provider Business Practice Location Address Fax Number:
507-386-1379
Provider Enumeration Date:
04/16/2012

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: 225X00000X , with the licence number:  101435 , 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)





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