1609147875 NPI number — MS. HELENE GABRIELLE OLEJNICZAK-LADEN

Table of content: MS. HELENE GABRIELLE OLEJNICZAK-LADEN (NPI 1609147875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609147875 NPI number — MS. HELENE GABRIELLE OLEJNICZAK-LADEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLEJNICZAK-LADEN
Provider First Name:
HELENE
Provider Middle Name:
GABRIELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LADEN
Provider Other First Name:
GABRIELLE
Provider Other Middle Name:
O.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1609147875
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1244 RUTLEDGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53703-3827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-257-7212
Provider Business Mailing Address Fax Number:
608-257-7212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
675 W WASHINGTON AVE
Provider Second Line Business Practice Location Address:
CAPITOL CLINIC
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53703-2637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-662-5090
Provider Business Practice Location Address Fax Number:
608-662-5091
Provider Enumeration Date:
01/19/2012

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: 225700000X , with the licence number:  1335-146 , 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)





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