1578520383 NPI number — JOYCE ELAINE LEIS RN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578520383 NPI number — JOYCE ELAINE LEIS RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEIS
Provider First Name:
JOYCE
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MELVIN
Provider Other First Name:
JOYCE
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578520383
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:
704 WALNUT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSCOBEL
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53805-1360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-375-4229
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
704 WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSCOBEL
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53805-1360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-375-4229
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2006

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: 163W00000X , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 38323600 . This is a "PN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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