1386843456 NPI number — REBECCA A HUISKEN O.D.

Table of content: REBECCA A HUISKEN O.D. (NPI 1386843456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386843456 NPI number — REBECCA A HUISKEN O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUISKEN
Provider First Name:
REBECCA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHULLER
Provider Other First Name:
REBECCA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386843456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1715 S BROADWAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ULM
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56073-3751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-354-8531
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1715 S BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ULM
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56073-3751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-354-8531
Provider Business Practice Location Address Fax Number:
507-359-1124
Provider Enumeration Date:
07/17/2007

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: 152W00000X , with the licence number:  3096 , 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: 139787 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1386843456 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6I476CH . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 930521052557 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 467693000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: HP84385 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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