1124132287 NPI number — MRS. JACQUELINE P STEWARD OTRL

Table of content: MRS. JACQUELINE P STEWARD OTRL (NPI 1124132287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124132287 NPI number — MRS. JACQUELINE P STEWARD OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEWARD
Provider First Name:
JACQUELINE
Provider Middle Name:
P
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTRL
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:
1124132287
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:
PO BOX 1004
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HINES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60141-1004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-846-8523
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HINES VA HOSPITAL
Provider Second Line Business Practice Location Address:
BLDG 228, ROOM B1021
Provider Business Practice Location Address City Name:
HINES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60141-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-202-8387
Provider Business Practice Location Address Fax Number:
708-202-2281
Provider Enumeration Date:
08/18/2006

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: 225X00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com