1831781871 NPI number — LATASHA SUNSHINE DEAN PLP

Table of content: LATASHA SUNSHINE DEAN PLP (NPI 1831781871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831781871 NPI number — LATASHA SUNSHINE DEAN PLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEAN
Provider First Name:
LATASHA
Provider Middle Name:
SUNSHINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PLP
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:
1831781871
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 COMMUNITY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64735-8804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-403-1071
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINDSOR
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65360-1449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-403-1071
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2021

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: 103TB0200X , with the licence number:  2021003133 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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