1477101566 NPI number — ELSIE MAE HORSTING INDIVIDUAL PROVIDER

Table of content: ELSIE MAE HORSTING INDIVIDUAL PROVIDER (NPI 1477101566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477101566 NPI number — ELSIE MAE HORSTING INDIVIDUAL PROVIDER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORSTING
Provider First Name:
ELSIE
Provider Middle Name:
MAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
INDIVIDUAL PROVIDER
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:
1477101566
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10679 US HIGHWAY 231 SOUTH
Provider Second Line Business Mailing Address:
10679 US HWY 231 SOUTH
Provider Business Mailing Address City Name:
LOOGOOTEE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47553-4952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-295-4680
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10679 US HIGHWAY 231 SOUTH
Provider Second Line Business Practice Location Address:
10679 US HWY 231 SOUTH
Provider Business Practice Location Address City Name:
LOOGOOTEE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47553-4952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-295-4680
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2019

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: 3747A0650X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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