1568421006 NPI number — JUDY A MISIASZEK APRN

Table of content: JUDY A MISIASZEK APRN (NPI 1568421006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568421006 NPI number — JUDY A MISIASZEK APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MISIASZEK
Provider First Name:
JUDY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
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:
1568421006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 ROUTE 125
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03848-3535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-642-6700
Provider Business Mailing Address Fax Number:
603-642-6701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 ROUTE 125
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03848-3535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-642-6700
Provider Business Practice Location Address Fax Number:
603-642-6701
Provider Enumeration Date:
03/22/2006

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: 363LA2200X , with the licence number:  027211-23-05 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2200X , with the licence number: 92779 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0327611 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 152212 . This is a "CIGNA NEW HAMPSHIRE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 7469782 . This is a "AETNA PPO" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1129363 . This is a "AETNA HMO" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30342329 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: NP4193 . This is a "BCBS MASSACHUSETTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7038239 . This is a "CIGNA NATIONAL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 23YP05046NH01 . This is a "BCBS NEW HAMPSHIRE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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