1669949319 NPI number — KENDRA JO POULSEN REGISTERED NURSE

Table of content: KENDRA JO POULSEN REGISTERED NURSE (NPI 1669949319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669949319 NPI number — KENDRA JO POULSEN REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POULSEN
Provider First Name:
KENDRA
Provider Middle Name:
JO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED NURSE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALL
Provider Other First Name:
KENDRA
Provider Other Middle Name:
JO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
REGISTERED NURSE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669949319
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 10 BOX 40
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIOCHE
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89043-9401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-589-2729
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
297 NEVADA NORTHERN RAIL WAY STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELY
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89301-2807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-293-6558
Provider Business Practice Location Address Fax Number:
775-289-1561
Provider Enumeration Date:
10/31/2018

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: 163WC1500X , with the licence number:  RN95615 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com