1033144415 NPI number — MS. ROMY PAIGE SUNDEM MA LMFT

Table of content: MARY K O'BRIEN MD (NPI 1952317927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033144415 NPI number — MS. ROMY PAIGE SUNDEM MA LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUNDEM
Provider First Name:
ROMY
Provider Middle Name:
PAIGE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA LMFT
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:
1033144415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2809 WAYZATA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55405-2125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-377-9190
Provider Business Mailing Address Fax Number:
612-374-4498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2809 WAYZATA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55405-2125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-377-9190
Provider Business Practice Location Address Fax Number:
612-374-4498
Provider Enumeration Date:
07/12/2006

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: 106H00000X , with the licence number:  933 , 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: 116042 . This is a "OPTUM" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP28452 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 922241025754 . This is a "PREFERRRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 126139C851 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6267255 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 99D37SU . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 168018800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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