1609837301 NPI number — EILEEN ANN KERR PA-C

Table of content: EILEEN ANN KERR PA-C (NPI 1609837301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609837301 NPI number — EILEEN ANN KERR PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KERR
Provider First Name:
EILEEN
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1609837301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HENNEPIN HEALTHCARE EAST LAKE CLINIC
Provider Second Line Business Mailing Address:
2700 E. LAKE ST #1100
Provider Business Mailing Address City Name:
MPLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-873-6963
Provider Business Mailing Address Fax Number:
612-276-0188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 E LAKE ST
Provider Second Line Business Practice Location Address:
#1100
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55406-1963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-873-8100
Provider Business Practice Location Address Fax Number:
612-276-0177
Provider Enumeration Date:
03/31/2006

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: 363A00000X , with the licence number:  9402 , 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: 507428200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 123263 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 01-20856 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: NA9021020591 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 77B41KE . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP30472 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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