1366624678 NPI number — MS. DIANNA RUTH COOPER-BOLINSKEY L.C.S.W.

Table of content: MS. DIANNA RUTH COOPER-BOLINSKEY L.C.S.W. (NPI 1366624678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366624678 NPI number — MS. DIANNA RUTH COOPER-BOLINSKEY L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOPER-BOLINSKEY
Provider First Name:
DIANNA
Provider Middle Name:
RUTH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
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:
1366624678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
INDIANA STATE UNIVERSITY
Provider Second Line Business Mailing Address:
749 CHESTNUT STREET, NURSING BLDG. #422
Provider Business Mailing Address City Name:
TERRE HAUTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47809-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-237-2322
Provider Business Mailing Address Fax Number:
812-237-8114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
609 E SURGERY CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47802-6815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-917-5091
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2007

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: 101YA0400X , with the licence number:  87000197A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 34005099A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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