1801033477 NPI number — MRS. TERESA MARIE WINEBRENNER PT

Table of content: MRS. TERESA MARIE WINEBRENNER PT (NPI 1801033477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801033477 NPI number — MRS. TERESA MARIE WINEBRENNER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINEBRENNER
Provider First Name:
TERESA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUTCHINS
Provider Other First Name:
TERESA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801033477
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 866308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75086-6308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-793-5464
Provider Business Mailing Address Fax Number:
267-321-1308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
854 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49423-7144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-392-9430
Provider Business Practice Location Address Fax Number:
616-392-5257
Provider Enumeration Date:
01/19/2009

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: 225100000X , with the licence number:  5501003984 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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