1982189262 NPI number — MR. WALDEN BROOK SCHLUNDT-CAPPS NP-NURSE PRACTITIONE

Table of content: MR. WALDEN BROOK SCHLUNDT-CAPPS NP-NURSE PRACTITIONE (NPI 1982189262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982189262 NPI number — MR. WALDEN BROOK SCHLUNDT-CAPPS NP-NURSE PRACTITIONE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHLUNDT-CAPPS
Provider First Name:
WALDEN
Provider Middle Name:
BROOK
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
NP-NURSE PRACTITIONE
Provider Gender Code:
M

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:
1982189262
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4913 DEARFOOT PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRUSSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35173
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-873-3200
Provider Business Mailing Address Fax Number:
205-655-5059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4913 DEARFOOT PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRUSSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-873-3200
Provider Business Practice Location Address Fax Number:
205-655-5059
Provider Enumeration Date:
10/02/2018

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: 363LF0000X , with the licence number:  1-141507 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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