1164570578 NPI number — ROCHELLE ANN DINGMANN OTRL

Table of content: ROCHELLE ANN DINGMANN OTRL (NPI 1164570578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164570578 NPI number — ROCHELLE ANN DINGMANN OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DINGMANN
Provider First Name:
ROCHELLE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOCHMANN
Provider Other First Name:
ROCHELLE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTRL
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164570578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
547 QUEENS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOORHEAD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56560-6777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-287-2017
Provider Business Mailing Address Fax Number:
701-232-2330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
921 43RD AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58102-5320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-793-3646
Provider Business Practice Location Address Fax Number:
701-232-2330
Provider Enumeration Date:
01/08/2007

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: 225XP0200X , with the licence number:  952 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XP0200X , with the licence number: 103216 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: HP53871 . This is a "HEALTH PARTNERS PROV. #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 370G3DI . This is a "EPNI PROVIDER NUMBER" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 370G3DI . This is a "BCBS MN PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 25708 . This is a "BCBS ND PROVIDER NUMBER" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 55077 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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