1831529965 NPI number — MRS. MARIA SOL TUDISCO DONAR MASTERS DEGREE IN PS

Table of content: MRS. MARIA SOL TUDISCO DONAR MASTERS DEGREE IN PS (NPI 1831529965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831529965 NPI number — MRS. MARIA SOL TUDISCO DONAR MASTERS DEGREE IN PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TUDISCO DONAR
Provider First Name:
MARIA
Provider Middle Name:
SOL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MASTERS DEGREE IN PS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TUDISCO
Provider Other First Name:
MARIA
Provider Other Middle Name:
SOL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MASTERS DEGREE IN PS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831529965
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 36 1155 N. ELM ST
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
PLATTEVILLE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53818-1207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-348-4060
Provider Business Mailing Address Fax Number:
608-348-4191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1155 N. ELM ST
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
PLATTEVILLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53818-1207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-348-4060
Provider Business Practice Location Address Fax Number:
608-348-4191
Provider Enumeration Date:
11/27/2013

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: 101Y00000X , with the licence number:  1899-226 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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