1295353035 NPI number — MRS. LAURIE MICHELLE GEEST LMT

Table of content: MRS. LAURIE MICHELLE GEEST LMT (NPI 1295353035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295353035 NPI number — MRS. LAURIE MICHELLE GEEST LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEEST
Provider First Name:
LAURIE
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WENDL
Provider Other First Name:
LAURIE
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295353035
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
813 1ST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVIS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61282-1079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-755-5203
Provider Business Mailing Address Fax Number:
309-755-5285

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
813 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVIS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61282-1079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-755-5203
Provider Business Practice Location Address Fax Number:
309-755-5285
Provider Enumeration Date:
07/08/2020

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: 225700000X , with the licence number:  227.021682 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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