1679867741 NPI number — FLORENCE CHRISTINE MORAN RD LMNT

Table of content: FLORENCE CHRISTINE MORAN RD LMNT (NPI 1679867741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679867741 NPI number — FLORENCE CHRISTINE MORAN RD LMNT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORAN
Provider First Name:
FLORENCE
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD LMNT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORAN
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
F
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD LMNT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1679867741
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
713 S 25TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEATRICE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68310-4179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-823-3574
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 N 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEATRICE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68310-2039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-481-7387
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2011

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: 133V00000X , with the licence number:  993 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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