Basic Information
Provider Information | |||||||||
NPI: | 1083637789 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SEARS | ||||||||
FirstName: | JANE | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN, MA, CNS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CHURCHILL | ||||||||
OtherFirstName: | JANE | ||||||||
OtherMiddleName: | MAIRE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RN, MA, CNS | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1095 HIGHWAY 15 S | ||||||||
Address2: |   | ||||||||
City: | HUTCHINSON | ||||||||
State: | MN | ||||||||
PostalCode: | 553505000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3202345000 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1095 HIGHWAY 15 S | ||||||||
Address2: |   | ||||||||
City: | HUTCHINSON | ||||||||
State: | MN | ||||||||
PostalCode: | 553505000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3202345000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/25/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0809X | R078918-5 | MN | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
No ID Information.