1447701644 NPI number — MS. JEANNE MARCILE CAFOUREK RN

Table of content: MS. JEANNE MARCILE CAFOUREK RN (NPI 1447701644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447701644 NPI number — MS. JEANNE MARCILE CAFOUREK RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAFOUREK
Provider First Name:
JEANNE
Provider Middle Name:
MARCILE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAU
Provider Other First Name:
JEANNE
Provider Other Middle Name:
MARCILE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447701644
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2423 22ND AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55904-5816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-280-7895
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2423 22ND AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55904-5816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-280-0193
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2016

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: 163W00000X , with the licence number:  R 92996-1 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 009309 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com