1811537608 NPI number — QI SI XUE NURSE PRACTITIONER

Table of content: (NPI 1295895134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811537608 NPI number — QI SI XUE NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
XUE
Provider First Name:
QI SI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
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:
1811537608
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17031 RUE VALENTINE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIERREFONDS
Provider Business Mailing Address State Name:
QC
Provider Business Mailing Address Postal Code:
H9J 3N1
Provider Business Mailing Address Country Code:
CA
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:
133 PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MALONE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12953-1244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
151-848-3300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2020

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: 363LF0000X , with the licence number:  345359 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 345359 . This is a "NEW YORK STATE EDUCATION DEPARTMENT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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