1255575361 NPI number — MRS. BRYANA MALNER ANDERT D.O.

Table of content: THERESA MARIE SAPORITO (NPI 1043717689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255575361 NPI number — MRS. BRYANA MALNER ANDERT D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERT
Provider First Name:
BRYANA
Provider Middle Name:
MALNER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MALNER
Provider Other First Name:
BRYANA
Provider Other Middle Name:
KRISTAN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255575361
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2925 CHICAGO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55407-1321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-262-5000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1217 8TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ULM
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56073-1552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-217-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2009

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: 207Q00000X , with the licence number:  53092 , 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