1487690616 NPI number — ANNE E KIDDER MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487690616 NPI number — ANNE E KIDDER MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KIDDER

Provider First Name:

ANNE

Provider Middle Name:

E

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

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:

1487690616

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/16/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 6001

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FARGO

Provider Business Mailing Address State Name:

ND

Provider Business Mailing Address Postal Code:

58108-6001

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

701-364-3300

Provider Business Mailing Address Fax Number:

701-364-8906

Provider First Line Business Practice Location Address:

1401 13TH AVE E

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

WEST FARGO

Provider Business Practice Location Address State Name:

ND

Provider Business Practice Location Address Postal Code:

58078-3468

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

701-364-5751

Provider Business Practice Location Address Fax Number:

701-364-5750

Provider Enumeration Date:

06/22/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  7428 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 10706 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
• Identifier: 58D29KI . This is a "MNBS-NP #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 15999 . This is a "NDBS FGO #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 0108117 . This is a "MEDICA-FGO #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 031018200 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
• Identifier: 0108117 . This is a "MEDICA-INN #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 0117889 . This is a "MEDICA NP #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 58D27KI . This is a "MNBS-FGO #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: DA9011026974 . This is a "PREF 1 #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: HP38246 . This is a "HEALTHPARTNERS #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 822783 . This is a "ARAZ #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".