1023130416 NPI number — MS. SANDRA MARIE MEYER OTR L

Table of content: MS. SANDRA MARIE MEYER OTR L (NPI 1023130416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023130416 NPI number — MS. SANDRA MARIE MEYER OTR L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEYER
Provider First Name:
SANDRA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR L
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:
1023130416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3058 WOODLARK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAGAN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55121-1915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-452-8963
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 AMERICAN BLVD W
Provider Second Line Business Practice Location Address:
THE HARTFORD
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55431-4420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-656-6321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2007

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: 225XN1300X , with the licence number:  100058 , 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: 270793 . This is a "NATIONAL REGISTRATION NUM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100058 . This is a "STATE LICENSURE NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com