1215540885 NPI number — MISS LAUREN ELIZABETH BURKHALTER STUDENT BA

Table of content: MISS LAUREN ELIZABETH BURKHALTER STUDENT BA (NPI 1215540885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215540885 NPI number — MISS LAUREN ELIZABETH BURKHALTER STUDENT BA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURKHALTER
Provider First Name:
LAUREN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
STUDENT BA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURKHALTER
Provider Other First Name:
LAUREN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
STUDENT BA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1215540885
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 CASTRO ST UNIT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73069-5962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-380-5752
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 CASTRO ST UNIT 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORMAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73069-5962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-380-5752
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2020

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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