1922003524 NPI number — BERNADETTE K PRICE CNM

Table of content: BERNADETTE K PRICE CNM (NPI 1922003524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922003524 NPI number — BERNADETTE K PRICE CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRICE
Provider First Name:
BERNADETTE
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
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:
1922003524
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1040 SIERRA DR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46143-7241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-528-4284
Provider Business Mailing Address Fax Number:
317-865-8355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
297 W FRANCISCAN DR
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
CROWN POINT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46307-4858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-662-6151
Provider Business Practice Location Address Fax Number:
219-662-6156
Provider Enumeration Date:
06/20/2005

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: 367A00000X , with the licence number:  09000074A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200314080 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000722777 . This is a "ANTHEM TRADITIONAL" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com