1699787358 NPI number — MRS. M DIANE ESTES LMHP CPC RN

Table of content: MRS. M DIANE ESTES LMHP CPC RN (NPI 1699787358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699787358 NPI number — MRS. M DIANE ESTES LMHP CPC RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESTES
Provider First Name:
M
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMHP CPC RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ABERCROMBIE
Provider Other First Name:
MARTHA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699787358
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:
3007 S 76TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68124-3409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-391-7353
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2833 S 87TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68124-3046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-398-9852
Provider Business Practice Location Address Fax Number:
402-398-9852
Provider Enumeration Date:
08/12/2006

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: 101YM0800X , with the licence number:  374 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10025268200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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