1801911250 NPI number — MS. JANISE BOGENSCHUTZ BRINDLEY RPH

Table of content: MS. JANISE BOGENSCHUTZ BRINDLEY RPH (NPI 1801911250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801911250 NPI number — MS. JANISE BOGENSCHUTZ BRINDLEY RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRINDLEY
Provider First Name:
JANISE
Provider Middle Name:
BOGENSCHUTZ
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
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:
1801911250
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:
16762 563 AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOOD THUNDER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-278-3142
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 SO BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56097-0036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-553-3161
Provider Business Practice Location Address Fax Number:
507-553-3914
Provider Enumeration Date:
03/21/2007

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: 183500000X , with the licence number:  1117633 , 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)





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