1386689040 NPI number — REBECCA L MADSEN APRN,CRNA, DNP

Table of content: REBECCA L MADSEN APRN,CRNA, DNP (NPI 1386689040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386689040 NPI number — REBECCA L MADSEN APRN,CRNA, DNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADSEN
Provider First Name:
REBECCA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN,CRNA, DNP
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:
1386689040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 PARK 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:
55415-1623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-873-6005
Provider Business Mailing Address Fax Number:
612-630-8242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55415-1623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-873-3152
Provider Business Practice Location Address Fax Number:
612-904-4218
Provider Enumeration Date:
06/18/2006

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: 367500000X , with the licence number:  038142 , 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: 8T944GO . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 749542100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".