1457658064 NPI number — MISS DAINA MARIE DUERR RD, LD, CD

Table of content: MISS DAINA MARIE DUERR RD, LD, CD (NPI 1457658064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457658064 NPI number — MISS DAINA MARIE DUERR RD, LD, CD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUERR
Provider First Name:
DAINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
RD, LD, CD
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:
1457658064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
257 W SAINT GEORGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANTSBURG
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54840-7827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-463-7372
Provider Business Mailing Address Fax Number:
715-463-2423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
257 W SAINT GEORGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANTSBURG
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54840-7827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-463-7372
Provider Business Practice Location Address Fax Number:
715-463-2423
Provider Enumeration Date:
02/16/2011

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: 133V00000X , with the licence number:  2193-029 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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