1528175155 NPI number — LYNN S OSOWSKI CRNA

Table of content: LYNN S OSOWSKI CRNA (NPI 1528175155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528175155 NPI number — LYNN S OSOWSKI CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSOWSKI
Provider First Name:
LYNN
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPITZER
Provider Other First Name:
LYNN
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1528175155
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2401 DEMERS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND FORKS
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-780-1891
Provider Business Mailing Address Fax Number:
701-746-7447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 S COLUMBIA RD - ALTRU HOSPITAL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-780-6000
Provider Business Practice Location Address Fax Number:
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: 367500000X , with the licence number:  R085589-9 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: R16793 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 416024000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12185 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 545S3OS . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 023002 . This is a "BCBS" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 430080275 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".