1063463438 NPI number — MRS. KARREN YVONNE ARVIDSON RN, CRNFA

Table of content: MRS. KARREN YVONNE ARVIDSON RN, CRNFA (NPI 1063463438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063463438 NPI number — MRS. KARREN YVONNE ARVIDSON RN, CRNFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARVIDSON
Provider First Name:
KARREN
Provider Middle Name:
YVONNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, CRNFA
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:
1063463438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20479 COUNTY 95
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAPORTE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56461-4122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-224-2121
Provider Business Mailing Address Fax Number:
218-224-4032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 ANNE ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEMIDJI
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56601-5103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-333-5773
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2006

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: 163W00000X , with the licence number:  R 068754-6 , 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: PR00 A09890912012 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: BC002 549T6AR . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: BC00 549T6AR . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP00 HP4919 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: PR23 A09890912012 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: C001 549T6AR . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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