1447236765 NPI number — JANET HOSTETLER C.N.P.

Table of content: JANET HOSTETLER C.N.P. (NPI 1447236765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447236765 NPI number — JANET HOSTETLER C.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOSTETLER
Provider First Name:
JANET
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
C.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447236765
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
245 STATE ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49503-4328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 CHERRY ST SE
Provider Second Line Business Practice Location Address:
STE 306
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49503-4607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-685-8750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2005

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: 363LW0102X , with the licence number:  4704291697 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HONP07061 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0700191 . This is a "UHC PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311413469054 . This is a "CARESOURCE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0989499 . This is a "GROUP MEDICAID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2013430 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500015909 . This is a "MEDICARE RAILROAD PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: CA1586 . This is a "GROUP MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".




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