1093860587 NPI number — MS. JOANN PATRICE FREY HAWKINS LP

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 1093860587 NPI number — MS. JOANN PATRICE FREY HAWKINS LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREY HAWKINS
Provider First Name:
JOANN
Provider Middle Name:
PATRICE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LP
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:
1093860587
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40700 CEDAR RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PETER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56082-5346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-931-9172
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 S 2ND ST
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
MANKATO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56001-3626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-387-1350
Provider Business Practice Location Address Fax Number:
507-387-6605
Provider Enumeration Date:
01/24/2007

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: 101YM0800X , with the licence number:  LP0414 , 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: 114893 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP28656 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1021817 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6H522FR . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6245487 . This is a "UNITED BEHAVORIAL HEALTH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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