1730365024 NPI number — BRETT ROBBINS MSN RN CS FNP INC

Table of content: DR. DEBRA BETH KLUEGER DO (NPI 1881649390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730365024 NPI number — BRETT ROBBINS MSN RN CS FNP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRETT ROBBINS MSN RN CS FNP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1730365024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1539
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84721-1539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-867-1960
Provider Business Mailing Address Fax Number:
435-867-1962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2002 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
CEDAR CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84721-9811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-867-1960
Provider Business Practice Location Address Fax Number:
435-867-1962
Provider Enumeration Date:
01/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ROBBINS
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
435-867-1960

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  216003-4405 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 68472 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 835681 . This is a "FIRST HEALTH NETWORK" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 528063826021 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21600344001001 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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