1457476798 NPI number — SHARON SINCERE FENN L.M.T.

Table of content: SHARON SINCERE FENN L.M.T. (NPI 1457476798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457476798 NPI number — SHARON SINCERE FENN L.M.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FENN
Provider First Name:
SHARON
Provider Middle Name:
SINCERE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.M.T.
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:
1457476798
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2201 LONG PRAIRIE RD
Provider Second Line Business Mailing Address:
SUITE 107320
Provider Business Mailing Address City Name:
FLOWER MOUND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75022-4832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-998-7911
Provider Business Mailing Address Fax Number:
972-692-8673

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5810 EXCELSIOR BLVD
Provider Second Line Business Practice Location Address:
C/O SPINE CARE, PA.
Provider Business Practice Location Address City Name:
ST LOUIS PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-998-7911
Provider Business Practice Location Address Fax Number:
952-927-8687
Provider Enumeration Date:
03/19/2007

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: 225700000X , 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: 225700000X . This is a "MASSAGE THERAPY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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