1891990644 NPI number — MYRA JEANNE KWAST-LIPKER LMHP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891990644 NPI number — MYRA JEANNE KWAST-LIPKER LMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KWAST-LIPKER
Provider First Name:
MYRA
Provider Middle Name:
JEANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHP
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:
1891990644
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:
710 E 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUPERIOR
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68978-2305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-879-3647
Provider Business Mailing Address Fax Number:
402-746-5684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 W 6TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED CLOUD
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68970-2278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-746-5614
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2007

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: 101YM0800X , with the licence number:  8145 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8145 . This is a "STATE LISENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com