1356500391 NPI number — THERESE ANTONELLI LANDIN MA CDE

Table of content: THERESE ANTONELLI LANDIN MA CDE (NPI 1356500391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356500391 NPI number — THERESE ANTONELLI LANDIN MA CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANDIN
Provider First Name:
THERESE
Provider Middle Name:
ANTONELLI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA CDE
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:
1356500391
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1099 CAPITOL STREET #200
Provider Second Line Business Mailing Address:
BOX 5407
Provider Business Mailing Address City Name:
EAGLE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81631-5407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-390-8311
Provider Business Mailing Address Fax Number:
855-615-3242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1099 CAPITOL STREET #200
Provider Second Line Business Practice Location Address:
BOX 5407
Provider Business Practice Location Address City Name:
EAGLE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81631-5407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-390-8311
Provider Business Practice Location Address Fax Number:
855-615-3242
Provider Enumeration Date:
06/05/2008

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: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com