1891777496 NPI number — JULIE CLAIRE SPARE MS

Table of content: JULIE CLAIRE SPARE MS (NPI 1891777496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891777496 NPI number — JULIE CLAIRE SPARE MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPARE
Provider First Name:
JULIE
Provider Middle Name:
CLAIRE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS
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:
1891777496
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:
600 25TH AVE S
Provider Second Line Business Mailing Address:
#109
Provider Business Mailing Address City Name:
SAINT CLOUD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56301-4841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-255-0343
Provider Business Mailing Address Fax Number:
320-654-0318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 25TH AVE S
Provider Second Line Business Practice Location Address:
#109
Provider Business Practice Location Address City Name:
SAINT CLOUD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56301-4841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-255-0343
Provider Business Practice Location Address Fax Number:
320-654-0318
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:  LP1570 , 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: 484059 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 966270898002 . This is a "PREFERED 1" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6229151 . This is a "UBH SELECT CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 191030 . This is a "MAYO MANAGEMENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25556 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5581858 . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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