1023346798 NPI number — ELIZABETH THERKILSEN CNP

Table of content: ELIZABETH THERKILSEN CNP (NPI 1023346798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023346798 NPI number — ELIZABETH THERKILSEN CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THERKILSEN
Provider First Name:
ELIZABETH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
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:
1023346798
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 772
Provider Second Line Business Mailing Address:
MINUTECLINIC CREDENTIALING, ATTN: KRISTY OLIVER
Provider Business Mailing Address City Name:
WOONSOCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02895-0784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-770-1707
Provider Business Mailing Address Fax Number:
401-652-9787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7901 BASS LAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HOPE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55428-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-257-0130
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/18/2009

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: 363LF0000X , with the licence number:  R 111685-4 , 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)





Copyright © 2007-2025 www.npivalidator.com