1932240025 NPI number — DR. KATHLEEN A NORDSTROM M.D.

Table of content: DR. KATHLEEN A NORDSTROM M.D. (NPI 1932240025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932240025 NPI number — DR. KATHLEEN A NORDSTROM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORDSTROM
Provider First Name:
KATHLEEN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1932240025
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5598
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BISMARCK
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58506-5598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-222-6100
Provider Business Mailing Address Fax Number:
701-222-6150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 N 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BISMARCK
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58501-4445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-222-6100
Provider Business Practice Location Address Fax Number:
701-222-6150
Provider Enumeration Date:
02/09/2007

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: 2085R0001X , with the licence number:  8881 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7704010 . This is a "DR NORDSTROM SD MEDICAID" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 920006668 . This is a "DR NORDSTROM RR MEDICARE" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 11727 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21230 . This is a "DR NORDSTROM BCBS" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 8881 . This is a "STATE LIC#" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".




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