1609948694 NPI number — MS. JENNIFER M SESLEY RD, CDE

Table of content: MS. JENNIFER M SESLEY RD, CDE (NPI 1609948694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609948694 NPI number — MS. JENNIFER M SESLEY RD, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SESLEY
Provider First Name:
JENNIFER
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RD, CDE
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:
1609948694
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
419 S WASHINGTON ST STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASPER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82601-2951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-577-2592
Provider Business Mailing Address Fax Number:
307-233-0260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
419 S WASHINGTON ST STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASPER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82601-2951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-577-2592
Provider Business Practice Location Address Fax Number:
307-233-0260
Provider Enumeration Date:
11/14/2006

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: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 145317300 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 312529 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".