1174637060 NPI number — DR. AGNIESZKA S HATFIELD M.D.

Table of content: DR. AGNIESZKA S HATFIELD M.D. (NPI 1174637060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174637060 NPI number — DR. AGNIESZKA S HATFIELD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HATFIELD
Provider First Name:
AGNIESZKA
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1174637060
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11850 BLACKFOOT ST NW STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COON RAPIDS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55433-2583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-236-1900
Provider Business Mailing Address Fax Number:
763-236-9010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11850 BLACKFOOT ST NW STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COON RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55433-2583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-236-1900
Provider Business Practice Location Address Fax Number:
763-236-9010
Provider Enumeration Date:
08/18/2006

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: 2086S0122X , with the licence number:  K2093 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: 44333 , 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: 180700500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7581471 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 180700500 . This is a "MA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1300140 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 131146 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 131MOHA . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: C03935 . This is a "MEDICARE CORPORATION" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 92321 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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