1528403151 NPI number — MRS. SONYA ANN STUTZMAN PTA

Table of content: MRS. SONYA ANN STUTZMAN PTA (NPI 1528403151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528403151 NPI number — MRS. SONYA ANN STUTZMAN PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STUTZMAN
Provider First Name:
SONYA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TATUM
Provider Other First Name:
SONYA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528403151
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 ARGO ST APT D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61571-3257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-267-3961
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13609 CALIFORNIA STREET
Provider Second Line Business Practice Location Address:
AUREUS MEDICAL
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-891-1118
Provider Business Practice Location Address Fax Number:
402-895-7812
Provider Enumeration Date:
05/09/2013

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: 225200000X , with the licence number:  160.005574 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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