1174618755 NPI number — ELIZABETH ELLEN KLEPPEN RN, PA-C

Table of content: ELIZABETH ELLEN KLEPPEN RN, PA-C (NPI 1174618755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174618755 NPI number — ELIZABETH ELLEN KLEPPEN RN, PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEPPEN
Provider First Name:
ELIZABETH
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, PA-C
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:
1174618755
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 266
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OUTLOOK
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59252-0266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-895-2520
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
818 2ND AVENUE EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CULBERTSON
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59218-0110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-787-6400
Provider Business Practice Location Address Fax Number:
406-787-6473
Provider Enumeration Date:
10/03/2006

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: 363A00000X , with the licence number:  120 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0438555 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95551004 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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