1720265184 NPI number — MEGAN MARIE DANIELSON RN CNP

Table of content: MEGAN MARIE DANIELSON RN CNP (NPI 1720265184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720265184 NPI number — MEGAN MARIE DANIELSON RN CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DANIELSON
Provider First Name:
MEGAN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN CNP
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:
1720265184
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5520 RIDGEWOOD COVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNETRISTA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-865-5262
Provider Business Mailing Address Fax Number:
952-472-3837

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3188 COUNTY ROAD 30 SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELANO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55328-8135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-972-3860
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2008

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: 363LG0600X , with the licence number:  R159309-5 , 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: 634472000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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