1134149552 NPI number — MARIE BRAATEN NP

Table of content: MARIE BRAATEN NP (NPI 1134149552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134149552 NPI number — MARIE BRAATEN NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAATEN
Provider First Name:
MARIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134149552
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
712 SOUTH CASCADE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FERGUS FALLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56537-2813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-736-8000
Provider Business Mailing Address Fax Number:
218-736-8757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
712 SOUTH CASCADE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERGUS FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56537-2813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-736-8000
Provider Business Practice Location Address Fax Number:
218-736-8757
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  0257609-23 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04-12780 . This is a "MEDICA NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1011589 . This is a "PREFERRED ONE NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 19848 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29T22BR . This is a "BCBS NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP26497 . This is a "HEALTHPARTNERS NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 123438 . This is a "UCARE NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 747022300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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