1598912040 NPI number — ELLEN JANE NEUMANN APN, ANP-BC, MSN

Table of content: ELLEN JANE NEUMANN APN, ANP-BC, MSN (NPI 1598912040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598912040 NPI number — ELLEN JANE NEUMANN APN, ANP-BC, MSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEUMANN
Provider First Name:
ELLEN
Provider Middle Name:
JANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN, ANP-BC, MSN
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:
1598912040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12255 DE PAUL DR
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
BRIDGETON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63044-2510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-739-4166
Provider Business Mailing Address Fax Number:
314-739-2485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12655 OLIVE BLVD
Provider Second Line Business Practice Location Address:
4TH FLOOR
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141-6362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-851-1000
Provider Business Practice Location Address Fax Number:
314-851-4468
Provider Enumeration Date:
08/26/2008

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:  085537 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com