1679672257 NPI number — MS. ROBERTA MANSFIELD APRN

Table of content: MS. ROBERTA MANSFIELD APRN (NPI 1679672257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679672257 NPI number — MS. ROBERTA MANSFIELD APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANSFIELD
Provider First Name:
ROBERTA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
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:
1679672257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 SW CORPORATE VW
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66615-1244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-234-0880
Provider Business Mailing Address Fax Number:
785-271-2220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 SW CORPORATE VW
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66615-1244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-234-0880
Provider Business Practice Location Address Fax Number:
785-271-2220
Provider Enumeration Date:
09/21/2006

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: 363LF0000X , with the licence number:  44508 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100285990C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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