1497714646 NPI number — MS. REBECCA S JIMENEZ C.R.N.A.

Table of content: MS. REBECCA S JIMENEZ C.R.N.A. (NPI 1497714646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497714646 NPI number — MS. REBECCA S JIMENEZ C.R.N.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JIMENEZ
Provider First Name:
REBECCA
Provider Middle Name:
S
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
C.R.N.A.
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:
1497714646
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1215 PLEASANT STREET
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50309-1418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-241-5722
Provider Business Mailing Address Fax Number:
515-241-4403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 PLEASANT STREET
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50309-1418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-241-5722
Provider Business Practice Location Address Fax Number:
515-241-4403
Provider Enumeration Date:
03/17/2006

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: 367500000X , with the licence number:  D064621 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X , with the licence number: 123902 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0139097 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: D064621 . This is a "TRICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 430028515 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 421008717 . This is a "JOHN DEERE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 54421 . This is a "BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com