1629047592 NPI number — DR. JEANMARIE BECHTLE DNP, ANP-BC, CCD

Table of content: DR. JEANMARIE BECHTLE DNP, ANP-BC, CCD (NPI 1629047592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629047592 NPI number — DR. JEANMARIE BECHTLE DNP, ANP-BC, CCD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BECHTLE
Provider First Name:
JEANMARIE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP, ANP-BC, CCD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOCKWOOD
Provider Other First Name:
JEANMARIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629047592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
KOHL'S WELLNESS CENTER -MANAGED BY QUAD MEDICAL
Provider Second Line Business Mailing Address:
300 ADMIRAL BYRD DRIVE
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-723-4069
Provider Business Mailing Address Fax Number:
540-535-7278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
190 CAMPUS BLVD
Provider Second Line Business Practice Location Address:
STE 420
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22601-2872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-931-0400
Provider Business Practice Location Address Fax Number:
540-667-9453
Provider Enumeration Date:
03/14/2006

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: 363LA2200X , with the licence number:  0024105790 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2200X , with the licence number: AC000498 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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