1780935098 NPI number — MAYVILLE NURSING AND REHABILITATION CENTER

Table of content: MRS. STACY MARIE DALRYMPLE CNM (NPI 1134821325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780935098 NPI number — MAYVILLE NURSING AND REHABILITATION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAYVILLE NURSING AND REHABILITATION CENTER
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:
1780935098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12785 W BOBWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BERLIN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53151-6970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 S CLARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYVILLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53050-1488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-387-0354
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HAMDAN
Authorized Official First Name:
FATMEH
Authorized Official Middle Name:
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
414-517-9223

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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