NPI |
1215314117 |
The State code in the location of the provider
being identified. |
Entity Type Code |
1 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Last Name Legal Name |
SKORIC |
The country code in the location address of the provider being identified. |
Provider First Name |
JELENA |
The telephone number associated with the location address of the provider being identified. |
Provider Credential Text |
HEARING AID DEALER |
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
Provider First Line Business Practice Location Address |
5462 STATE ST |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
SAGINAW |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
MI |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
486033678 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
9897937620 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
9897932044 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
4/29/2015 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Last Update Date |
4/29/2015 |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Provider Gender Code |
F |
|
Healthcare Provider Taxonomy Code 1 |
237700000X |
|
Provider License Number 1 |
3501004940 |
|
Provider License Number State Code 1 |
MI |
|
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |