1851409395 NPI number — DIANE SIONE TANABE MD

Table of content: DIANE SIONE TANABE MD (NPI 1851409395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851409395 NPI number — DIANE SIONE TANABE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANABE
Provider First Name:
DIANE
Provider Middle Name:
SIONE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1851409395
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 18128
Provider Second Line Business Mailing Address:
LUFKIN EYE CLINIC, PA
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55118-0128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-292-8205
Provider Business Mailing Address Fax Number:
651-292-1801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 SMITH AVE N STE 400
Provider Second Line Business Practice Location Address:
LUFKIN EYE CLINIC, PA
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55102-2473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-292-8200
Provider Business Practice Location Address Fax Number:
651-292-1801
Provider Enumeration Date:
08/25/2006

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: 207W00000X , with the licence number:  21440 , 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: 841890000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180010745 . This is a "PALMETTO GBA RAILROAD MED" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 28943TA . This is a "BCBS OF MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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