1770906109 NPI number — MRS. ELIZABETH LORENE HINZMANN ARNP

Table of content: MRS. ELIZABETH LORENE HINZMANN ARNP (NPI 1770906109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770906109 NPI number — MRS. ELIZABETH LORENE HINZMANN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HINZMANN
Provider First Name:
ELIZABETH
Provider Middle Name:
LORENE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
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:
1770906109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1288 VALLEY VIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COUNCIL BLUFFS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51503-5245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-328-8800
Provider Business Mailing Address Fax Number:
712-328-8461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3502 METRO DRIVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
COUNCIL BLUFFS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-256-7172
Provider Business Practice Location Address Fax Number:
712-256-7374
Provider Enumeration Date:
01/21/2014

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: 363L00000X , with the licence number:  A121973 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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