1144256116 NPI number — VANESSA LYNNE-KOSCHTIAL HOWE MSPT

Table of content: VANESSA LYNNE-KOSCHTIAL HOWE MSPT (NPI 1144256116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144256116 NPI number — VANESSA LYNNE-KOSCHTIAL HOWE MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOWE
Provider First Name:
VANESSA
Provider Middle Name:
LYNNE-KOSCHTIAL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSPT
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:
1144256116
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
245 BARCLAY CIR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
ROCHESTER HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48307-5815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-991-0801
Provider Business Mailing Address Fax Number:
586-991-0804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 BARCLAY CIR
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
ROCHESTER HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48307-5815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-991-0801
Provider Business Practice Location Address Fax Number:
586-991-0804
Provider Enumeration Date:
06/23/2006

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: 174400000X , with the licence number:  5501006539 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 650E014930 . This is a "BLUE CROSS BLUE SHIELD OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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