1184691719 NPI number — RENEE ANN WEIR-FISHER D.C.

Table of content: RENEE ANN WEIR-FISHER D.C. (NPI 1184691719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184691719 NPI number — RENEE ANN WEIR-FISHER D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEIR-FISHER
Provider First Name:
RENEE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEIR
Provider Other First Name:
RENEE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1184691719
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
702 S GILBERT ST
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
IOWA CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52240-1738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-248-1111
Provider Business Mailing Address Fax Number:
319-248-1111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
702 S GILBERT ST
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52240-1738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-248-1111
Provider Business Practice Location Address Fax Number:
319-248-1111
Provider Enumeration Date:
03/02/2006

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: 111N00000X , with the licence number:  06566 , 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: 24277 . This is a "BLUE CROSS PROVIDER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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