1932545902 NPI number — MRS. HERA JANE LONETREE-RINDAHL SAC

Table of content: MRS. HERA JANE LONETREE-RINDAHL SAC (NPI 1932545902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932545902 NPI number — MRS. HERA JANE LONETREE-RINDAHL SAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONETREE-RINDAHL
Provider First Name:
HERA
Provider Middle Name:
JANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SAC
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:
1932545902
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 918
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLACK RIVER FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54615-0918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-284-9851
Provider Business Mailing Address Fax Number:
715-284-3434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
W9850 AIRPORT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLACK RIVER FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-284-9851
Provider Business Practice Location Address Fax Number:
715-284-3434
Provider Enumeration Date:
05/17/2013

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: 101YA0400X , with the licence number:  15876 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com