Provider Demographics
NPI:1649323429
Name:ROCKWELL CITY LYTTON SCHOOL DISTRICT
Entity type:Organization
Organization Name:ROCKWELL CITY LYTTON SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL NURSE REGISTERED NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ERICSSON
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:712-297-7341
Mailing Address - Street 1:1000 TONAWANDA AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50579
Mailing Address - Country:US
Mailing Address - Phone:712-297-7341
Mailing Address - Fax:712-297-7320
Practice Address - Street 1:1000 TONAWANDA AVE
Practice Address - Street 2:ROCKWELL CITY LYTTON HIGH SCHOOL
Practice Address - City:ROCKWELL CITY
Practice Address - State:IA
Practice Address - Zip Code:50579
Practice Address - Country:US
Practice Address - Phone:712-297-7341
Practice Address - Fax:712-297-7320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA097435163W00000X
251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251300000XAgenciesLocal Education Agency (LEA)
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1649323429Medicaid