1104878313 NPI number — HILARY ARMSTRONG WINKELMANN FNP

Table of content: ISAAC ADDIE BCBA (NPI 1407688542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104878313 NPI number — HILARY ARMSTRONG WINKELMANN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINKELMANN
Provider First Name:
HILARY
Provider Middle Name:
ARMSTRONG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1104878313
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 SILVER LAKE ROAD NW
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
NEW BRIGHTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-379-1718
Provider Business Mailing Address Fax Number:
651-379-1738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7300 W 147TH STREET
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-997-3020
Provider Business Practice Location Address Fax Number:
952-997-3026
Provider Enumeration Date:
05/16/2006

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: 363LF0000X , with the licence number:  212432-4 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 2321 , 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: 07579366 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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