1164425112 NPI number — DR. BRIAN JOHN ISETTS B.C.P.S., PH.D.

Table of content: JENNIFER ANGLEN (NPI 1821706524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164425112 NPI number — DR. BRIAN JOHN ISETTS B.C.P.S., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ISETTS
Provider First Name:
BRIAN
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
B.C.P.S., PH.D.
Provider Gender Code:
M

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:
1164425112
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:
3510 WILD TURKEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED WING
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55066-1765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-385-8353
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
308 HARVARD ST SE
Provider Second Line Business Practice Location Address:
RM 7-175
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55455-0353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-624-2140
Provider Business Practice Location Address Fax Number:
612-625-9931
Provider Enumeration Date:
05/23/2005

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: 1835P1200X , with the licence number:  113541-1 , 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)





Copyright © 2007-2025 www.npivalidator.com