1255583779 NPI number — MS. CHRYSTEL SCHORTAU HOHMANN LMT

Table of content: MS. CHRYSTEL SCHORTAU HOHMANN LMT (NPI 1255583779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255583779 NPI number — MS. CHRYSTEL SCHORTAU HOHMANN LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOHMANN
Provider First Name:
CHRYSTEL
Provider Middle Name:
SCHORTAU
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMT
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:
1255583779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1164 6TH AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAYETTE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83661-2480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-235-6061
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 S WHITLEY DR
Provider Second Line Business Practice Location Address:
FRUITLAND BUSINESS CENTER SUITE 3
Provider Business Practice Location Address City Name:
FRUITLAND
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83619-2611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-235-6061
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2008

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: 225700000X , with the licence number:  7726 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CH1026883 . This is a "AMERICAN HEALTH SPECIALTY HEALTH NETWORKS,INC." identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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