1689675563 NPI number — PETRA M LAEVEN-SESSIONS MD

Table of content: PETRA M LAEVEN-SESSIONS MD (NPI 1689675563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689675563 NPI number — PETRA M LAEVEN-SESSIONS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAEVEN-SESSIONS
Provider First Name:
PETRA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MESSICK-LAEVEN
Provider Other First Name:
PETRA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689675563
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 2ND ST
Provider Second Line Business Mailing Address:
PEDIATRIC HOSPITALIST DEPT
Provider Business Mailing Address City Name:
NEENAH
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54956-2883
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-969-7900
Provider Business Mailing Address Fax Number:
920-969-7979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 2ND ST
Provider Second Line Business Practice Location Address:
PEDIATRIC HOSPITALIST DEPT
Provider Business Practice Location Address City Name:
NEENAH
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54956-2883
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-969-7900
Provider Business Practice Location Address Fax Number:
920-969-7979
Provider Enumeration Date:
08/02/2005

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: 208000000X , with the licence number:  9639 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 62317-20 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: MD60147163 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2011936 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1689675563 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0028424 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com