1962574665 NPI number — DR. JEANNE MARIE BEHREND PHD

Table of content: DR. JEANNE MARIE BEHREND PHD (NPI 1962574665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962574665 NPI number — DR. JEANNE MARIE BEHREND PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEHREND
Provider First Name:
JEANNE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1962574665
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:
850 SCHUSTER ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUN PRAIRIE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53590-2437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-837-9700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5610 MEDICAL CIRCLE
Provider Second Line Business Practice Location Address:
SUITE 25
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53719-1295
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-274-5871
Provider Business Practice Location Address Fax Number:
608-274-5764
Provider Enumeration Date:
11/15/2006

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: 103TB0200X , with the licence number:  1113057 , 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)

  • Identifier: 50639 . This is a "NATIONAL REGISTER OF HEAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 39034400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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