1205801255 NPI number — DEBRA L STEALEY APRN, CNM

Table of content: DEBRA L STEALEY APRN, CNM (NPI 1205801255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205801255 NPI number — DEBRA L STEALEY APRN, CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEALEY
Provider First Name:
DEBRA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, CNM
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:
1205801255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6565 FRANCE AVE S
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55435-2137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-806-0011
Provider Business Mailing Address Fax Number:
952-806-9741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6565 FRANCE AVE S
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-2137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-806-0011
Provider Business Practice Location Address Fax Number:
952-806-9741
Provider Enumeration Date:
02/22/2006

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: 363LX0001X , with the licence number:  6165 , 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: 442T7ST . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 189740300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: HP17205 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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