1386385839 NPI number — BROOKE KATHLEEN MATTEO AUD

Table of content: BROOKE KATHLEEN MATTEO AUD (NPI 1386385839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386385839 NPI number — BROOKE KATHLEEN MATTEO AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATTEO
Provider First Name:
BROOKE
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAYSINGER
Provider Other First Name:
BROOKE
Provider Other Middle Name:
KATHLEEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386385839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1648
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97440-1648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-334-3370
Provider Business Mailing Address Fax Number:
541-334-3372

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 S GARDEN WAY STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401-8185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-334-3370
Provider Business Practice Location Address Fax Number:
541-334-3372
Provider Enumeration Date:
04/06/2022

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 31035 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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