1831193754 NPI number — MRS. SHERRIE HELEN STUMP MA, F-AAA

Table of content: MRS. SHERRIE HELEN STUMP MA, F-AAA (NPI 1831193754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831193754 NPI number — MRS. SHERRIE HELEN STUMP MA, F-AAA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STUMP
Provider First Name:
SHERRIE
Provider Middle Name:
HELEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, F-AAA
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:
1831193754
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1040 DELAWARE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43302-6416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-383-8060
Provider Business Mailing Address Fax Number:
740-383-7974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 DELAWARE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43302-6416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-383-8060
Provider Business Practice Location Address Fax Number:
740-383-7974
Provider Enumeration Date:
06/09/2005

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: 231H00000X , with the licence number:  A-01316 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0100147 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com