1912339946 NPI number — SHAWNA LYNNE SMITHBAUER M.A., NCC

Table of content: SHAWNA LYNNE SMITHBAUER M.A., NCC (NPI 1912339946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912339946 NPI number — SHAWNA LYNNE SMITHBAUER M.A., NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITHBAUER
Provider First Name:
SHAWNA
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOFFMAN
Provider Other First Name:
SHAWNA
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, NCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912339946
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 PEMBROKE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-6404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-396-1510
Provider Business Mailing Address Fax Number:
724-972-4627

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E HIGHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EBENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15931-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-396-1510
Provider Business Practice Location Address Fax Number:
724-972-4627
Provider Enumeration Date:
08/01/2013

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: PC008494 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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