1275649873 NPI number — LAURIE JEAN WHITBECK LPN, OPA-C

Table of content: LAURIE JEAN WHITBECK LPN, OPA-C (NPI 1275649873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275649873 NPI number — LAURIE JEAN WHITBECK LPN, OPA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITBECK
Provider First Name:
LAURIE
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPN, OPA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NELSON
Provider Other First Name:
LAURIE
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN, OPA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275649873
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6465 WAYZATA BLVD
Provider Second Line Business Mailing Address:
SUITE 900
Provider Business Mailing Address City Name:
ST LOUIS PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55426-1728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-512-5600
Provider Business Mailing Address Fax Number:
952-512-5650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
775 PRAIRIE CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
EDEN PRAIRIE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55344-7314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-944-2519
Provider Business Practice Location Address Fax Number:
952-944-0460
Provider Enumeration Date:
08/23/2006

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: 364SM0705X , with the licence number:  L0264862 , 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: HP42523 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".




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