1194895888 NPI number — PAULA C DEARHOLT RN, WHCNP

Table of content: PAULA C DEARHOLT RN, WHCNP (NPI 1194895888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194895888 NPI number — PAULA C DEARHOLT RN, WHCNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEARHOLT
Provider First Name:
PAULA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, WHCNP
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:
1194895888
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 CYPRESS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANKATO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56001-7575
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
671 VANDALIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55114-1312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-368-2798
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/09/2006

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: 363LW0102X , with the licence number:  R124952-7 , 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: 122972 . This is a "UCARE PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP26447 . This is a "HEALTH PARTNERS PROV ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 666420200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1068173 . This is a "AMERICA'S PPO PROV ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 29076 . This is a "SIOUX VALLEY PROV ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1016947 . This is a "PREFERRED ONE PROV ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 68G08DE . This is a "BCBS MN PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 07-00637 . This is a "MEDICA PROVIDER ID" identifier . This identifiers is of the category "OTHER".




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