1154448728 NPI number — MRS. BETTY ANN MACHA RN, BSN, MS

Table of content: MRS. BETTY ANN MACHA RN, BSN, MS (NPI 1154448728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154448728 NPI number — MRS. BETTY ANN MACHA RN, BSN, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACHA
Provider First Name:
BETTY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, BSN, MS
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:
1154448728
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:
1930 CHEROKEE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA CROSSE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54603-1502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-782-3124
Provider Business Mailing Address Fax Number:
608-785-6315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1407 SAINT ANDREW ST
Provider Second Line Business Practice Location Address:
ST 100
Provider Business Practice Location Address City Name:
LA CROSSE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54603-3301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-785-5923
Provider Business Practice Location Address Fax Number:
608-785-6315
Provider Enumeration Date:
03/26/2007

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: 163WC1500X , with the licence number:  48844030 , 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)





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