1528327343 NPI number — FABIANE HIRSCH KRUSE PH.D.

Table of content: FABIANE HIRSCH KRUSE PH.D. (NPI 1528327343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528327343 NPI number — FABIANE HIRSCH KRUSE PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HIRSCH KRUSE
Provider First Name:
FABIANE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HIRSCH
Provider Other First Name:
FABIANE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1528327343
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1011 N CRAYCROFT RD
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85711-7309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-730-8428
Provider Business Mailing Address Fax Number:
520-300-8328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1011 N CRAYCROFT RD
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85711-7309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-730-8428
Provider Business Practice Location Address Fax Number:
520-300-8328
Provider Enumeration Date:
05/14/2012

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: 235Z00000X , with the licence number:  SLP#1636 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 713722 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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