1821182924 NPI number — NANCY JO HEIN-KOLO PSYD

Table of content: NANCY JO HEIN-KOLO PSYD (NPI 1821182924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821182924 NPI number — NANCY JO HEIN-KOLO PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEIN-KOLO
Provider First Name:
NANCY
Provider Middle Name:
JO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSYD
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:
1821182924
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1606 C 30TH AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOORHEAD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-287-4338
Provider Business Mailing Address Fax Number:
218-287-5928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1606 C 30TH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOORHEAD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-287-4338
Provider Business Practice Location Address Fax Number:
218-287-5928
Provider Enumeration Date:
10/03/2006

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: 103TC0700X , with the licence number:  3314 , 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: 6165134 . This is a "UBH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21463 . This is a "BLUE CROSS" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 11761 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: HP30049 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1022602 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 067322600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1400L4HE . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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