1619039369 NPI number — MS. SUSAN HANS OTRL

Table of content: MS. SUSAN HANS OTRL (NPI 1619039369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619039369 NPI number — MS. SUSAN HANS OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANS
Provider First Name:
SUSAN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTRL
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:
1619039369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24941 AMERICA CENTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUSTER
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57730-8335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-367-4736
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24941 AMERICA CENTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUSTER
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57730-8335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-367-4736
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2006

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: 225XP0200X , with the licence number:  0750 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LAN22704 . This is a "BCBS ND PROVIDER NUMBER" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 2239246 . This is a "FIRST HEALTH" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: HP75679 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: B17351047567 . This is a "PREFERREDONE PIN NUMBER" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 385492000 . This is a "MHCP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 54430 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64-04763 . This is a "MEDICA PROVIDER NUMBER" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".




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