1447229026 NPI number — MARYNNE L KOPISCHKE N.P.

Table of content: MARYNNE L KOPISCHKE N.P. (NPI 1447229026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447229026 NPI number — MARYNNE L KOPISCHKE N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOPISCHKE
Provider First Name:
MARYNNE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.
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:
1447229026
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6545 FRANCE AVE S
Provider Second Line Business Mailing Address:
STE 210
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55435-2281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-928-2900
Provider Business Mailing Address Fax Number:
952-928-2944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6545 FRANCE AVE S
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-2281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-928-2900
Provider Business Practice Location Address Fax Number:
952-928-2944
Provider Enumeration Date:
03/16/2006

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: 363LA2200X , with the licence number:  R113270-2 , 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: 43841400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 780824100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007082 . This is a "PREFERREDONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4305471 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 851169 . This is a "AMERICA'S PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8T414KO . This is a "BLUECROSS BLUE SHIELD MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0410560 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 151560 . This is a "UCARE MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP33242 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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