1790767721 NPI number — SUSAN JANE AKINS MSN RN BC AP MHCNS

Table of content: SUSAN JANE AKINS MSN RN BC AP MHCNS (NPI 1790767721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790767721 NPI number — SUSAN JANE AKINS MSN RN BC AP MHCNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AKINS
Provider First Name:
SUSAN
Provider Middle Name:
JANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN RN BC AP MHCNS
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:
1790767721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2120 MADISON AVE
Provider Second Line Business Mailing Address:
STE 404
Provider Business Mailing Address City Name:
GRANITE CITY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62040-4744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-876-7515
Provider Business Mailing Address Fax Number:
618-876-7596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3535 S JEFFERSON AVE
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63118-3930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-776-7999
Provider Business Practice Location Address Fax Number:
314-772-2257
Provider Enumeration Date:
11/16/2005

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: 364S00000X , with the licence number:  048345 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 364S00000X , with the licence number: 209004686 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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