1275602401 NPI number — MRS. KAREN ESTELLE NOVARA MS RN CNSBC LADC

Table of content: MRS. KAREN ESTELLE NOVARA MS RN CNSBC LADC (NPI 1275602401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275602401 NPI number — MRS. KAREN ESTELLE NOVARA MS RN CNSBC LADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOVARA
Provider First Name:
KAREN
Provider Middle Name:
ESTELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS RN CNSBC LADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHWANKE
Provider Other First Name:
KAREN
Provider Other Middle Name:
ESTELLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275602401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1625 JOHNSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STILLWATER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55082
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-351-2904
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1675 GREELEY ST
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
STILLWATER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-275-1214
Provider Business Practice Location Address Fax Number:
651-275-1214
Provider Enumeration Date:
11/06/2006

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: 101YA0400X , with the licence number:  300942 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 163W00000X , with the licence number: R1391750 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 163WP0809X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 77B53N0 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 77B52N0 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP34005 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8263875 . This is a "UBH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 75704 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".




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