1902983315 NPI number — MRS. JENNIFER CHRISTINE KORINEK MPT

Table of content: MRS. JENNIFER CHRISTINE KORINEK MPT (NPI 1902983315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902983315 NPI number — MRS. JENNIFER CHRISTINE KORINEK MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KORINEK
Provider First Name:
JENNIFER
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CANINE
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902983315
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:
5401 SOUTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68506-2150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-486-8469
Provider Business Mailing Address Fax Number:
402-486-9098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5401 SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68506-2150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-486-8469
Provider Business Practice Location Address Fax Number:
402-486-9098
Provider Enumeration Date:
11/01/2006

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: 225100000X , with the licence number:  1351 , 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)





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