1285791202 NPI number — DR. DIANE PATRICIA BARRETT PHD LP

Table of content: DR. DIANE PATRICIA BARRETT PHD LP (NPI 1285791202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285791202 NPI number — DR. DIANE PATRICIA BARRETT PHD LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARRETT
Provider First Name:
DIANE
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD LP
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:
1285791202
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 RAMSEY ST
Provider Second Line Business Mailing Address:
RAMSEY PROFESSIONAL BUILDING
Provider Business Mailing Address City Name:
ST PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-291-8070
Provider Business Mailing Address Fax Number:
651-227-6559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 RAMSEY ST
Provider Second Line Business Practice Location Address:
RAMSEY PROFESSIONAL BUILDING
Provider Business Practice Location Address City Name:
ST PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-291-8070
Provider Business Practice Location Address Fax Number:
651-227-6559
Provider Enumeration Date:
01/02/2007

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: 103T00000X , with the licence number:  LP1631MN , 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: 415848200 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4H795BA . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 111535 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".




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