1952322604 NPI number — DR. NALISA LOUISE POULIOT D.C.

Table of content: DR. NALISA LOUISE POULIOT D.C. (NPI 1952322604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952322604 NPI number — DR. NALISA LOUISE POULIOT D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POULIOT
Provider First Name:
NALISA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CURTIS
Provider Other First Name:
NALISA
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952322604
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:
4321 NE VIVION RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64119-2838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-453-3331
Provider Business Mailing Address Fax Number:
816-453-3331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4321 NE VIVION RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64119-2838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-453-3331
Provider Business Practice Location Address Fax Number:
816-453-3331
Provider Enumeration Date:
07/21/2006

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: 111N00000X , with the licence number:  006425 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 24021014 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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