1477661692 NPI number — PLATTEVILLE FAMILY RESOURCE CENTER INC

Table of content: RACHEL ANNE BRINER PA (NPI 1316324015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477661692 NPI number — PLATTEVILLE FAMILY RESOURCE CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLATTEVILLE FAMILY RESOURCE CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1477661692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 E BUSINESS HWY 151
Provider Second Line Business Mailing Address:
STE D
Provider Business Mailing Address City Name:
PLATTEVILLE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-348-4060
Provider Business Mailing Address Fax Number:
608-348-4191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 E BUSINESS HWY 151
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
PLATTEVILLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-348-4060
Provider Business Practice Location Address Fax Number:
608-348-4191
Provider Enumeration Date:
08/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WRUBLE
Authorized Official First Name:
MARC
Authorized Official Middle Name:
KEVIN
Authorized Official Title or Position:
DIRECTOR OWNER
Authorized Official Telephone Number:
608-348-4060

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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