1336388388 NPI number — MRS. CORIENE MARIE PLOETZ M.S., N.C.C.

Table of content: MRS. CORIENE MARIE PLOETZ M.S., N.C.C. (NPI 1336388388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336388388 NPI number — MRS. CORIENE MARIE PLOETZ M.S., N.C.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLOETZ
Provider First Name:
CORIENE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., N.C.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROBBINS
Provider Other First Name:
CORIENE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336388388
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
612 N RANDALL AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
JANESVILLE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53545-1958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-752-7660
Provider Business Mailing Address Fax Number:
608-752-9788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
612 N RANDALL AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
JANESVILLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53545-1958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-752-7660
Provider Business Practice Location Address Fax Number:
608-752-9788
Provider Enumeration Date:
02/16/2009

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: 101YM0800X , with the licence number:  55-226 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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