1720370190 NPI number — DR. GINA MARCELLINE REKOW D.C.

Table of content: DR. GINA MARCELLINE REKOW D.C. (NPI 1720370190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720370190 NPI number — DR. GINA MARCELLINE REKOW D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REKOW
Provider First Name:
GINA
Provider Middle Name:
MARCELLINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
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:
KRAUSHAR
Provider Other First Name:
GINA
Provider Other Middle Name:
MARCELLINE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720370190
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2211 8TH AVE NE STE 2101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABERDEEN
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57401-3232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-725-5545
Provider Business Mailing Address Fax Number:
605-725-5546

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2211 8TH AVE NE STE 2101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57401-3232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-725-5545
Provider Business Practice Location Address Fax Number:
605-725-5546
Provider Enumeration Date:
05/04/2011

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: 111N00000X , with the licence number:  1190 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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