1164804951 NPI number — SYDNIE HOLLAN PARISH WASCHBISCH COTA

Table of content: SYDNIE HOLLAN PARISH WASCHBISCH COTA (NPI 1164804951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164804951 NPI number — SYDNIE HOLLAN PARISH WASCHBISCH COTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WASCHBISCH
Provider First Name:
SYDNIE
Provider Middle Name:
HOLLAN PARISH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
COTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARISH
Provider Other First Name:
SYDNIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
COTA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164804951
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2927 S FISH HATCHERY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FITCHBURG
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53711-6498
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-819-6394
Provider Business Mailing Address Fax Number:
608-204-6183

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2927 S FISH HATCHERY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FITCHBURG
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53711-6498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-819-6394
Provider Business Practice Location Address Fax Number:
608-204-6183
Provider Enumeration Date:
06/29/2015

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: 224Z00000X , with the licence number:  5185-027 , registered in the state of WI ; 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