1891845004 NPI number — LINDA DEANNE DURST-OTTMERS LVN

Table of content: LINDA DEANNE DURST-OTTMERS LVN (NPI 1891845004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891845004 NPI number — LINDA DEANNE DURST-OTTMERS LVN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DURST-OTTMERS
Provider First Name:
LINDA
Provider Middle Name:
DEANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LVN
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:
1891845004
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:
819 WATER ST
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
KERRVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78028-5333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-792-3300
Provider Business Mailing Address Fax Number:
830-792-5771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1328 HIGHWAY 16S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-997-9503
Provider Business Practice Location Address Fax Number:
830-997-4320
Provider Enumeration Date:
01/11/2007

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: 164X00000X , with the licence number:  82809 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 82809 . This is a "LVN LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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