1942531348 NPI number — MRS. ELIZABETH MARIE ROHLICH APN

Table of content: MRS. ELIZABETH MARIE ROHLICH APN (NPI 1942531348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942531348 NPI number — MRS. ELIZABETH MARIE ROHLICH APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROHLICH
Provider First Name:
ELIZABETH
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APN
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:
1942531348
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
802 W DRAKE RD
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80526-5567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-391-1751
Provider Business Mailing Address Fax Number:
512-391-1906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1313 RED RIVER ST
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78701-1943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-391-1751
Provider Business Practice Location Address Fax Number:
512-391-1906
Provider Enumeration Date:
01/25/2010

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: 364SA2200X , with the licence number:  747396 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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