1437269099 NPI number — CHERYL NAOMI REINKE C.O.T.A

Table of content: CHERYL NAOMI REINKE C.O.T.A (NPI 1437269099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437269099 NPI number — CHERYL NAOMI REINKE C.O.T.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REINKE
Provider First Name:
CHERYL
Provider Middle Name:
NAOMI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
C.O.T.A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KLEIN
Provider Other First Name:
CHERYL
Provider Other Middle Name:
NAOMI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
C.O.T.A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437269099
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:
2300 WESTERN AVE
Provider Second Line Business Mailing Address:
PO BOX 2170
Provider Business Mailing Address City Name:
MANITOWOC
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54220-3712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-320-8667
Provider Business Mailing Address Fax Number:
920-320-8616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 WESTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANITOWOC
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54220-3712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-320-2397
Provider Business Practice Location Address Fax Number:
920-320-8616
Provider Enumeration Date:
08/30/2006

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: 224Z00000X , with the licence number:  503-027 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 40643700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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