1932321718 NPI number — MRS. KIRSTEN NOEL EVANS-ROMANO LOTR

Table of content: MRS. KIRSTEN NOEL EVANS-ROMANO LOTR (NPI 1932321718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932321718 NPI number — MRS. KIRSTEN NOEL EVANS-ROMANO LOTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANS-ROMANO
Provider First Name:
KIRSTEN
Provider Middle Name:
NOEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LOTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROMANO
Provider Other First Name:
KIRSTEN
Provider Other Middle Name:
NOEL EVANS
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LOTR
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1932321718
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:
PO BOX 41151
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70835-1151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-819-7360
Provider Business Mailing Address Fax Number:
225-769-2441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8128 FLORIDA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENHAM SPRINGS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70726-7865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-791-8666
Provider Business Practice Location Address Fax Number:
225-791-8644
Provider Enumeration Date:
05/03/2007

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: 225X00000X , with the licence number:  Z12161 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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