1851565774 NPI number — MISS MARCY ANN NEITZER PTA

Table of content: MISS MARCY ANN NEITZER PTA (NPI 1851565774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851565774 NPI number — MISS MARCY ANN NEITZER PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEITZER
Provider First Name:
MARCY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PTA
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:
1851565774
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E HIGHLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCONTO FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-848-3272
Provider Business Mailing Address Fax Number:
920-848-7833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E HIGHLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCONTO FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-848-3272
Provider Business Practice Location Address Fax Number:
920-848-7833
Provider Enumeration Date:
04/22/2008

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: 225200000X , with the licence number:  1183019 , 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)

  • Identifier: 40463700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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