1306808670 NPI number — PATRICIA SUZANNE DOSTALEK CNM

Table of content: PATRICIA SUZANNE DOSTALEK CNM (NPI 1306808670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306808670 NPI number — PATRICIA SUZANNE DOSTALEK CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOSTALEK
Provider First Name:
PATRICIA
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
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:
1306808670
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30280
Provider Second Line Business Mailing Address:
OBSTETRIX MEDICAL GROUP OF AZ, P.C.
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85751-0280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-881-3936
Provider Business Mailing Address Fax Number:
520-795-0626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5301 E GRANT RD
Provider Second Line Business Practice Location Address:
OBSTETRIX MEDICAL GROUP OF AZ, P.C.
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85712-2805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-881-3936
Provider Business Practice Location Address Fax Number:
520-795-0626
Provider Enumeration Date:
04/03/2006

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: 367A00000X , with the licence number:  080636 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 157924 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080636 . This is a "RN LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 166 . This is a "APRN RECOGNITION" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 102 . This is a "NURSE MIDWIFE CERTIFICATE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 216287 . This is a "RN LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00145 . This is a "ARNP CERTIFICATE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 40189 . This is a "RN LICENSE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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