1114276896 NPI number — MEGHAN MARIE SCHNELLENBERGER AUD

Table of content: MEGHAN MARIE SCHNELLENBERGER AUD (NPI 1114276896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114276896 NPI number — MEGHAN MARIE SCHNELLENBERGER AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHNELLENBERGER
Provider First Name:
MEGHAN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
O'CONNOR
Provider Other First Name:
MEGHAN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AUD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114276896
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9002 N MERIDIAN STREET
Provider Second Line Business Mailing Address:
SUITE 222
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46260-5350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-573-4370
Provider Business Mailing Address Fax Number:
317-819-0044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9002 N MERIDIAN ST
Provider Second Line Business Practice Location Address:
STE 222
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46260-5350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-573-4370
Provider Business Practice Location Address Fax Number:
317-819-0044
Provider Enumeration Date:
09/10/2012

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: 231H00000X , with the licence number:  23002518A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 201117330 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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