1811903636 NPI number — MS. KAREN ANNE TYSZKOWSKI RNCNS

Table of content: MS. KAREN ANNE TYSZKOWSKI RNCNS (NPI 1811903636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811903636 NPI number — MS. KAREN ANNE TYSZKOWSKI RNCNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TYSZKOWSKI
Provider First Name:
KAREN
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RNCNS
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:
1811903636
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1130 TEN ROD ROAD
Provider Second Line Business Mailing Address:
SUITE E204
Provider Business Mailing Address City Name:
NORTH KINGSTOWN
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-294-9600
Provider Business Mailing Address Fax Number:
401-295-7395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1130 TEN ROD ROAD
Provider Second Line Business Practice Location Address:
SUITE E204
Provider Business Practice Location Address City Name:
NORTH KINGSTOWN
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-294-9600
Provider Business Practice Location Address Fax Number:
401-295-7395
Provider Enumeration Date:
08/01/2006

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: 163WP0808X , with the licence number:  RN11331 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000003469001 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00406295001 . This is a "BLUE CHIP CP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1023160 . This is a "BEACON" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 370170 . This is a "MAGELLAN UNITED HC" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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