1568570455 NPI number — NATHALIE CROTEAU PT

Table of content: NATHALIE CROTEAU PT (NPI 1568570455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568570455 NPI number — NATHALIE CROTEAU PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROTEAU
Provider First Name:
NATHALIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1568570455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2573 STONEMAN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH POLE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99705-5631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-488-3613
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3455 REWAK DR
Provider Second Line Business Practice Location Address:
STE 106
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99709-5003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-457-5322
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2006

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: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1078 . This is a "LICENSE #" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com