1538195953 NPI number — CARRIE DAWN MEYER AUD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538195953 NPI number — CARRIE DAWN MEYER AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEYER
Provider First Name:
CARRIE
Provider Middle Name:
DAWN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HATHAWAY
Provider Other First Name:
CARRIE
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AUD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538195953
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
560 S MAPLE ST
Provider Second Line Business Mailing Address:
SUITE 40
Provider Business Mailing Address City Name:
WACONIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55387-1733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-925-5626
Provider Business Mailing Address Fax Number:
952-442-2180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
560 S MAPLE ST
Provider Second Line Business Practice Location Address:
SUITE 40
Provider Business Practice Location Address City Name:
WACONIA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55387-1733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-925-5626
Provider Business Practice Location Address Fax Number:
952-442-2180
Provider Enumeration Date:
06/25/2006

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: 231H00000X , with the licence number:  6392 , 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: 231H00000X . This is a "TAXONOMY CODE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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