1114480712 NPI number — MOLLY E HOPPENJAN P.T

Table of content: MOLLY E HOPPENJAN P.T (NPI 1114480712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114480712 NPI number — MOLLY E HOPPENJAN P.T

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOPPENJAN
Provider First Name:
MOLLY
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WUBBEN
Provider Other First Name:
MOLLY
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114480712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1705 DELHI STREET, LOWER LEVEL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBUQUE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52001-5900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-582-4170
Provider Business Mailing Address Fax Number:
563-582-4181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 JOHN F KENNEDY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBUQUE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52002-2843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-588-3891
Provider Business Practice Location Address Fax Number:
563-588-3893
Provider Enumeration Date:
04/10/2019

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: 225100000X , with the licence number:  093234 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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