1184629107 NPI number — DENISE M DEFALCO-MCGEEIN APN

Table of content: DENISE M DEFALCO-MCGEEIN APN (NPI 1184629107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184629107 NPI number — DENISE M DEFALCO-MCGEEIN APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEFALCO-MCGEEIN
Provider First Name:
DENISE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEFALCO
Provider Other First Name:
DENISE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184629107
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4480 UTICA RIDGE RD
Provider Second Line Business Mailing Address:
STE 1140
Provider Business Mailing Address City Name:
BETTENDORF
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52722-1656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-742-5700
Provider Business Mailing Address Fax Number:
563-742-5705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4480 UTICA RIDGE RD
Provider Second Line Business Practice Location Address:
STE 1140
Provider Business Practice Location Address City Name:
BETTENDORF
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52722-1656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-742-5700
Provider Business Practice Location Address Fax Number:
563-742-5705
Provider Enumeration Date:
06/16/2005

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: 363LW0102X , with the licence number:  209-003068 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LW0102X , with the licence number: F-103719 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1184629107 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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