1912111014 NPI number — DANA L HELLEBUSCH RN, MSN, CDE, FNP-BC

Table of content: DANA L HELLEBUSCH RN, MSN, CDE, FNP-BC (NPI 1912111014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912111014 NPI number — DANA L HELLEBUSCH RN, MSN, CDE, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HELLEBUSCH
Provider First Name:
DANA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN, CDE, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HELLEBUSCH
Provider Other First Name:
DANA
Provider Other Middle Name:
L
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:
1912111014
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1351 JEFFERSON ST STE 208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63090-6449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-235-4858
Provider Business Mailing Address Fax Number:
877-669-0615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1351 JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63090-6441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-235-4858
Provider Business Practice Location Address Fax Number:
877-669-0615
Provider Enumeration Date:
05/09/2007

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: 163WD0400X , with the licence number:  113794 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 113794 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 429908205 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com