1326009051 NPI number — AMBER LYNN HANSON PADDOCK MD

Table of content: AMBER LYNN HANSON PADDOCK MD (NPI 1326009051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326009051 NPI number — AMBER LYNN HANSON PADDOCK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PADDOCK
Provider First Name:
AMBER
Provider Middle Name:
LYNN HANSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HANSON
Provider Other First Name:
AMBER
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326009051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 43
Provider Second Line Business Mailing Address:
MR 10809
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55440-0043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-262-4813
Provider Business Mailing Address Fax Number:
612-262-4194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 CHICAGO AVE
Provider Second Line Business Practice Location Address:
250
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55407-1318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-863-4096
Provider Business Practice Location Address Fax Number:
612-863-2132
Provider Enumeration Date:
03/31/2006

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: 207R00000X , with the licence number:  42550 , 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)





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