1992235568 NPI number — MS. MICHAELA MARIE LOXTERMAN LAC

Table of content: MS. MICHAELA MARIE LOXTERMAN LAC (NPI 1992235568)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992235568 NPI number — MS. MICHAELA MARIE LOXTERMAN LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOXTERMAN
Provider First Name:
MICHAELA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LAC
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:
1992235568
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1805 SOUTH OHIO STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALINA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-825-6224
Provider Business Mailing Address Fax Number:
785-825-1433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 SW 10TH AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-825-6224
Provider Business Practice Location Address Fax Number:
785-825-1433
Provider Enumeration Date:
06/15/2017

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:  808 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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