1447557285 NPI number — DR. PEGGY MARIE MAUDE-GRIFFIN PH.D., LP

Table of content: DR. PEGGY MARIE MAUDE-GRIFFIN PH.D., LP (NPI 1447557285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447557285 NPI number — DR. PEGGY MARIE MAUDE-GRIFFIN PH.D., LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAUDE-GRIFFIN
Provider First Name:
PEGGY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., LP
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:
1447557285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7235 OHMS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55439-2148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-841-2345
Provider Business Mailing Address Fax Number:
952-841-2346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7235 OHMS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55439-2148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-841-2345
Provider Business Practice Location Address Fax Number:
952-841-2346
Provider Enumeration Date:
02/14/2011

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: 103TC0700X , with the licence number:  LP 4110 , 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)





Copyright © 2007-2024 www.npivalidator.com