1386425056 NPI number — EVA-ANNE MARIE KENTNER ARNP

Table of content: EVA-ANNE MARIE KENTNER ARNP (NPI 1386425056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386425056 NPI number — EVA-ANNE MARIE KENTNER ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENTNER
Provider First Name:
EVA-ANNE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
EVA-ANNE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1386425056
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 498
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED OAK
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51566-0498
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-623-7000
Provider Business Mailing Address Fax Number:
712-623-7224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 EASTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED OAK
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51566-1305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-623-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2023

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: 207Q00000X , with the licence number:  A175901 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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