1235360272 NPI number — MRS. STEPHANIE LYNN SEUBERT RN

Table of content: MRS. STEPHANIE LYNN SEUBERT RN (NPI 1235360272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235360272 NPI number — MRS. STEPHANIE LYNN SEUBERT RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEUBERT
Provider First Name:
STEPHANIE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PINNOW
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235360272
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 S 12TH ST
Provider Second Line Business Mailing Address:
SUITE 4710, MC 635
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55404-1004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-596-7067
Provider Business Mailing Address Fax Number:
612-466-9652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 S 12TH ST
Provider Second Line Business Practice Location Address:
SUITE 4710, MC 635
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55404-1004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-596-7067
Provider Business Practice Location Address Fax Number:
612-466-9652
Provider Enumeration Date:
08/06/2009

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: 163WC1500X , with the licence number:  R 79245-7 , 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)





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