1548295157 NPI number — MS. JILL ELIZABETH MANSKE MSW

Table of content: MS. JILL ELIZABETH MANSKE MSW (NPI 1548295157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548295157 NPI number — MS. JILL ELIZABETH MANSKE MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANSKE
Provider First Name:
JILL
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
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:
1548295157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12209 ROWAN TREE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22030-6230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-815-7953
Provider Business Mailing Address Fax Number:
202-273-8385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
OF VETERANS AFFAIRS
Provider Second Line Business Practice Location Address:
810 VERMONT AVENUE NW
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20420-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-273-8549
Provider Business Practice Location Address Fax Number:
202-273-8385
Provider Enumeration Date:
07/11/2006

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03520 . This is a "LICENSED INDEPENDENT SW" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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