1679549000 NPI number — FAYE HELLER APRN/CNS

Table of content: FAYE HELLER APRN/CNS (NPI 1679549000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679549000 NPI number — FAYE HELLER APRN/CNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HELLER
Provider First Name:
FAYE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN/CNS
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:
1679549000
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5040 SW 28TH ST
Provider Second Line Business Mailing Address:
STE. C
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66614-2302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-273-4908
Provider Business Mailing Address Fax Number:
785-273-0465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5040 SW 28TH ST
Provider Second Line Business Practice Location Address:
STE. C
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66614-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-273-4908
Provider Business Practice Location Address Fax Number:
785-273-0465
Provider Enumeration Date:
02/25/2006

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: 363LP0808X , with the licence number:  74019 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0808X , with the licence number: 209004413 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 160593 . This is a "PTAN -ISSUED BT KS MEDICARE/BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100249920B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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