1316079882 NPI number — MS. LINDA ANNE SYLVESTER LPT, CEAS

Table of content: MS. LINDA ANNE SYLVESTER LPT, CEAS (NPI 1316079882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316079882 NPI number — MS. LINDA ANNE SYLVESTER LPT, CEAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SYLVESTER
Provider First Name:
LINDA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPT, CEAS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SYLVESTER
Provider Other First Name:
LINDA
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPT, CEAS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1316079882
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1524 PITNER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60201-3961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-315-2459
Provider Business Mailing Address Fax Number:
847-475-1434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1524 PITNER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60201-3961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-315-2459
Provider Business Practice Location Address Fax Number:
847-475-1434
Provider Enumeration Date:
03/11/2007

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: 225100000X , with the licence number:  070004423 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9342454 . This is a "PHCS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 01634535 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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