1508013566 NPI number — MRS. DIANNE MARIE GOETTL NCR REFLEXOLOGIST

Table of content: MRS. DIANNE MARIE GOETTL NCR REFLEXOLOGIST (NPI 1508013566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508013566 NPI number — MRS. DIANNE MARIE GOETTL NCR REFLEXOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOETTL
Provider First Name:
DIANNE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NCR REFLEXOLOGIST
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:
1508013566
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1610 MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMER
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-568-5173
Provider Business Mailing Address Fax Number:
715-568-2673

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1610 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMER
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-568-5173
Provider Business Practice Location Address Fax Number:
715-568-2673
Provider Enumeration Date:
08/21/2008

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: 173C00000X , with the licence number:  B01208 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9455705 . This is a "COMMUNITY HEALTH PARTNERSHIP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com