1376266817 NPI number — MRS. GRACE ELLEN RAHTJEN HIS

Table of content: MRS. GRACE ELLEN RAHTJEN HIS (NPI 1376266817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376266817 NPI number — MRS. GRACE ELLEN RAHTJEN HIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAHTJEN
Provider First Name:
GRACE
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
HIS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PIERSON
Provider Other First Name:
GRACE
Provider Other Middle Name:
ELLEN
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:
1376266817
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
919 PRIVATE ROAD 1712
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MICO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78056-5571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-370-2777
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1112 S MAIN ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOERNE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78006-2812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-609-9056
Provider Business Practice Location Address Fax Number:
830-893-0132
Provider Enumeration Date:
09/20/2022

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: 237700000X , with the licence number:  81000 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 81000 . This is a "TEXAS DEPARTMENT OF LICENSING AND REGULATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com