1760921472 NPI number — MIDWEST INTEGRATIVE HEALTH

Table of content: JESSICA CATHERINE FOWLE PHARMD (NPI 1972155497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760921472 NPI number — MIDWEST INTEGRATIVE HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST INTEGRATIVE HEALTH
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:
1760921472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4611 S 96TH ST
Provider Second Line Business Mailing Address:
SUITE 139
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68127-1202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-281-0825
Provider Business Mailing Address Fax Number:
402-281-0852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4611 S 96TH ST
Provider Second Line Business Practice Location Address:
SUITE 139
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68127-1202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-281-0825
Provider Business Practice Location Address Fax Number:
402-281-0852
Provider Enumeration Date:
02/14/2017

Additional Information

Authorized Official

Authorized Official Last Name:
FOLKERS
Authorized Official First Name:
JACEY
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
402-281-0825

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , 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)





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