MRS. AMANDA B KUBERSKI LPN, NPI 1124197256 — CHRISTOPHER (IL)

NPI 1124197256

13+ Years Experience Individual

MRS. AMANDA B KUBERSKI LPN

11.06.2006
PROVIDER ENUMERATION DATE
07.08.2007
LAST UPDATE DATE
1124197256
NPI NUMBER

About MRS. AMANDA B KUBERSKI

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

MRS. AMANDA B KUBERSKI is a provider established in CHRISTOPHER, IL. The NPI number of MRS. AMANDA B KUBERSKI is 1124197256 and was assigned on 11.06.2006. The practitioners primary taxonomy code is: 164W00000X IL .

Mailing address

  • City: CHRISTOPHER
  • State: IL
  • Postal code: 62822
  • Phone: 6187242401
  • Fax: 6187242571
  • Address: REA CLINIC
  • Address 2: PO BOX 155

Primary Practice Address

  • Region : CHRISTOPHER, IL
  • NPI : 1124197256
  • Phone : 6187242401
  • Fax : 6187242571
  • Postalcode : 62822
  • Address : REA CLINIC 4241 HIGHWAY 14 WEST

Provider taxonomy - Licensed Practical Nurse

  • Taxonomy code: 164W00000X
  • License state: IL

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

Contacts:

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  • MRS. AMANDA B KUBERSKI LPN
  • Address : REA CLINIC 4241 HIGHWAY 14 WEST
  • Region : CHRISTOPHER, IL
  • NPI : 1124197256
  • Phone : 6187242401
  • Fax : 6187242571
  • Postalcode : 62822

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location AddressREA CLINIC
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 Second Line Business Practice Location Address4241 HIGHWAY 14 WEST
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 Business Practice Location Address City NameCHRISTOPHER
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameIL
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code62822
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 Telephone Number6187242401
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number6187242571
The fax number associated with the location address of the provider being identified.
NPI1124197256
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1164W00000X
An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.
Provider Enumeration Date11.06.2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07.08.2007
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)MRS. AMANDA B KUBERSKI
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing AddressREA CLINIC
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing AddressPO BOX 155
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NameCHRISTOPHER
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameIL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code62822
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number6187242401
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number6187242571
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #1164W00000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Licensed Practical Nurse
An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.
Provider License Number State Code 1IL
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Provider Gender CodeF
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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