1134425309 NPI number — MRS. NICOLE ELISE STEWART LMLP

Table of content: MRS. NICOLE ELISE STEWART LMLP (NPI 1134425309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134425309 NPI number — MRS. NICOLE ELISE STEWART LMLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEWART
Provider First Name:
NICOLE
Provider Middle Name:
ELISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIESLING
Provider Other First Name:
NICOLE
Provider Other Middle Name:
ELISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134425309
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
645 E IRON AVE
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
SALINA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67401-2697
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-823-0001
Provider Business Mailing Address Fax Number:
785-914-5250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
645 E IRON AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SALINA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67401-2697
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-823-0001
Provider Business Practice Location Address Fax Number:
785-914-5250
Provider Enumeration Date:
02/04/2011

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: 103TB0200X , with the licence number:  1486 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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