1225086952 NPI number — DR. TAWNDA RAE ANDREWS D.C.

Table of content: BRIGETTE MARIE BROWN CCC-SLP (NPI 1013251404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225086952 NPI number — DR. TAWNDA RAE ANDREWS D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDREWS
Provider First Name:
TAWNDA
Provider Middle Name:
RAE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VOLKER
Provider Other First Name:
TAWNDA
Provider Other Middle Name:
RAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1225086952
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
285 SAINT ANDREWS DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
MANKATO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56001-8670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-345-1926
Provider Business Mailing Address Fax Number:
507-345-1750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
285 SAINT ANDREWS DR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
MANKATO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56001-8670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-345-1926
Provider Business Practice Location Address Fax Number:
507-345-1750
Provider Enumeration Date:
05/05/2006

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: 111N00000X , with the licence number:  4577 , 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: 365410900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 83353VO . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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