1649473802 NPI number — TANYA R GETCHELL EMT-IT

Table of content: TANYA R GETCHELL EMT-IT (NPI 1649473802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649473802 NPI number — TANYA R GETCHELL EMT-IT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GETCHELL
Provider First Name:
TANYA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
EMT-IT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VANDEVENTER
Provider Other First Name:
TANYA
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
EMT-IT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649473802
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
886 HARBOR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILTON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53563-9621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-751-2292
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11101 N SHERMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGERTON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53534-9002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-751-2292
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2007

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: 146M00000X , with the licence number:  36785 , 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)

  • Identifier: 36785 . This is a "WI LICENSE NUMBER" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".