1235620709 NPI number — TALIA JORDAN KRAMER

Table of content: TALIA JORDAN KRAMER (NPI 1235620709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235620709 NPI number — TALIA JORDAN KRAMER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRAMER
Provider First Name:
TALIA
Provider Middle Name:
JORDAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1235620709
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 737
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOWARD LAKE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55349-0737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-543-1104
Provider Business Mailing Address Fax Number:
321-543-1105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
621 PARKER AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DASSEL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55325-1094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-275-1304
Provider Business Practice Location Address Fax Number:
320-275-0161
Provider Enumeration Date:
05/21/2018

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: 225100000X , with the licence number:  11055 , 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: 1174556682 . This is a "NPI" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com