1164494753 NPI number — NANCY M MCLOONE RN NP

Table of content: NANCY M MCLOONE RN NP (NPI 1164494753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164494753 NPI number — NANCY M MCLOONE RN NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCLOONE
Provider First Name:
NANCY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN 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:
1164494753
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1230 E MAIN ST PO BOX 8274
Provider Second Line Business Mailing Address:
MANKATO CLINIC LTD
Provider Business Mailing Address City Name:
MANKATO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56002-8674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-625-1811
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1230 E MAIN ST
Provider Second Line Business Practice Location Address:
MANKATO CLINIC LTD
Provider Business Practice Location Address City Name:
MANKATO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56002-8674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-625-1811
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2006

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: 363LP0200X , with the licence number:  R 072876-4 , 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: 1652657 . This is a "AMERICAS PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 938134 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1200704 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 121222 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: NA2951023875 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 477216400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02Q96MC . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 500004160 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP41026 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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