1386720506 NPI number — LANA OLIVO BEASLEY MA CCP TLMLP

Table of content: LANA OLIVO BEASLEY MA CCP TLMLP (NPI 1386720506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386720506 NPI number — LANA OLIVO BEASLEY MA CCP TLMLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEASLEY
Provider First Name:
LANA
Provider Middle Name:
OLIVO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA CCP TLMLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLIVO
Provider Other First Name:
LANA
Provider Other Middle Name:
SUZETTE
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:
1386720506
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 MAINE
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66044-1390
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-843-9192
Provider Business Mailing Address Fax Number:
785-843-6744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MAINE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66044-1390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-843-9192
Provider Business Practice Location Address Fax Number:
785-843-6744
Provider Enumeration Date:
10/31/2006

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: 103T00000X , with the licence number:  TLMLP1046 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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