1689799611 NPI number — MS. MARY LOUISE PEET R.D.

Table of content: MS. MARY LOUISE PEET R.D. (NPI 1689799611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689799611 NPI number — MS. MARY LOUISE PEET R.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEET
Provider First Name:
MARY
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
R.D.
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:
1689799611
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1365 DEBY PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80921-2282
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-481-3749
Provider Business Mailing Address Fax Number:
719-365-6727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MEMORIAL HEALTH SYSTEM
Provider Second Line Business Practice Location Address:
1400 EAST BOULDER ST
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-365-1832
Provider Business Practice Location Address Fax Number:
719-365-6727
Provider Enumeration Date:
03/20/2007

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: 133V00000X , with the licence number:  462779 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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