1982784591 NPI number — DIANE P MUCKENHIRN RN, WHCNP

Table of content: DIANE P MUCKENHIRN RN, WHCNP (NPI 1982784591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982784591 NPI number — DIANE P MUCKENHIRN RN, WHCNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUCKENHIRN
Provider First Name:
DIANE
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, WHCNP
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:
1982784591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19572 SKYVIEW CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUTCHINSON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55350-4316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-587-4907
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1965 FORD PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55116-1923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-696-5509
Provider Business Practice Location Address Fax Number:
651-698-2405
Provider Enumeration Date:
10/17/2006

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: 363LW0102X , with the licence number:  R0953856 , 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: HP16814 . This is a "HEALTH PARTNERS PROV. ID" identifier . This identifiers is of the category "OTHER".




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