1962548545 NPI number — DEBRA KIM MEUCHE CNM

Table of content: DEBRA KIM MEUCHE CNM (NPI 1962548545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962548545 NPI number — DEBRA KIM MEUCHE CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEUCHE
Provider First Name:
DEBRA
Provider Middle Name:
KIM
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:
1962548545
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5311 WALNUT GROVE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAVENNA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44266-8289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-297-6054
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6847 N CHESTNUT ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
RAVENNA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44266-3929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-296-4165
Provider Business Practice Location Address Fax Number:
330-296-5536
Provider Enumeration Date:
01/30/2007

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: 163W00000X , with the licence number:  RN-185626 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: CNM-03539 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2053674 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com