NPI |
1891024253 |
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. |
Entity Type Code |
1 |
The second 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 Last Name Legal Name |
SCRUBY |
The city name in the location address of the provider being identified. |
Provider First Name |
LORI |
The State code in the location of the provider
being identified. |
Provider Middle Name |
BETH |
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 Name Prefix Text |
MRS. |
The country code in the location address of the provider being identified. |
Provider Credential Text |
RN |
The telephone number associated with the location address of the provider being identified. |
Provider Other Last Name |
ESTEPP |
The fax number associated with the location
address of the provider being identified. |
Provider Other First Name |
LORI |
Other first name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider first name’’ if the provider is or has been known by a different last name only. |
Provider Other Middle Name |
BETH |
Other middle name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider middle name’’ if the provider
is or has been known by a different last name only. |
Provider Other Name Prefix Text |
MRS. |
The date that a record was last updated or changed. |
Provider Other Last Name Type Code |
1 |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider First Line Business Practice Location Address |
20 SPRING LAKE CT |
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 |
DELAWARE |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
OH |
The first name of the authorized official. |
Provider Business Practice Location Address Postal Code |
430153924 |
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 |
7408167041 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
7403624043 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
12/15/2009 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
12/15/2009 |
The date that a record was last updated or changed. |
Provider Gender Code |
F |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
163W00000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number 1 |
354429 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number State Code 1 |
OH |
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. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
Y |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |