1477036317 NPI number — GINA KLEVE DARDINE PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477036317 NPI number — GINA KLEVE DARDINE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DARDINE
Provider First Name:
GINA
Provider Middle Name:
KLEVE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERNIER
Provider Other First Name:
GINA
Provider Other Middle Name:
KLEVE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477036317
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 BROADWAY ST. NE
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-871-1145
Provider Business Mailing Address Fax Number:
612-870-5491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
237 RADIO DRIVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-502-5092
Provider Business Practice Location Address Fax Number:
612-870-5491
Provider Enumeration Date:
09/06/2018

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: 363A00000X , with the licence number:  12782 , 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)





Copyright © 2007-2025 www.npivalidator.com