1780171454 NPI number — LOTUS WOMB HEALING & AWAKENING

Table of content: ROBERT C. ROSENQUIST MD (NPI 1245307065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780171454 NPI number — LOTUS WOMB HEALING & AWAKENING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOTUS WOMB HEALING & AWAKENING
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:
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:
1780171454
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3353 N MARTIN LUTHER KING DR STE 133
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53212-1455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-909-2325
Provider Business Mailing Address Fax Number:
414-488-2253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3353 N MARTIN LUTHER KING DR STE 133
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53212-1455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-909-2325
Provider Business Practice Location Address Fax Number:
414-488-2253
Provider Enumeration Date:
04/18/2018

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPBELL
Authorized Official First Name:
RASHID
Authorized Official Middle Name:
JEREMIAH
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
414-909-2325

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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