1255654760 NPI number — JULIE DIANE PURVIS SLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255654760 NPI number — JULIE DIANE PURVIS SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PURVIS
Provider First Name:
JULIE
Provider Middle Name:
DIANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SLP
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:
1255654760
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50333-4250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-243-2057
Provider Business Mailing Address Fax Number:
515-244-5570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
604 LIBERTY ST
Provider Second Line Business Practice Location Address:
SUITE 229
Provider Business Practice Location Address City Name:
PELLA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50219-1775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-621-1122
Provider Business Practice Location Address Fax Number:
641-621-1177
Provider Enumeration Date:
03/11/2010

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: 235Z00000X , with the licence number:  002010 , 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: 002010 . This is a "LICENSE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".