1679555122 NPI number — MS. LINDA KAMSTRA GORDON M.A., L.P., L.A.D.C.

Table of content: MS. LINDA KAMSTRA GORDON M.A., L.P., L.A.D.C. (NPI 1679555122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679555122 NPI number — MS. LINDA KAMSTRA GORDON M.A., L.P., L.A.D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GORDON
Provider First Name:
LINDA
Provider Middle Name:
KAMSTRA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., L.P., L.A.D.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:
1679555122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4651 NICOLS RD
Provider Second Line Business Mailing Address:
SUITE 102A
Provider Business Mailing Address City Name:
EAGAN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55122-3336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-688-3168
Provider Business Mailing Address Fax Number:
651-688-3583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4651 NICOLS RD
Provider Second Line Business Practice Location Address:
SUITE 102A
Provider Business Practice Location Address City Name:
EAGAN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55122-3336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-688-3168
Provider Business Practice Location Address Fax Number:
651-688-3583
Provider Enumeration Date:
11/18/2005

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: 103T00000X , with the licence number:  LP3677 , 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)





Copyright © 2007-2024 www.npivalidator.com