1487781514 NPI number — KRISTINE M MEYER-RUBADO MA, LP

Table of content: KRISTINE M MEYER-RUBADO MA, LP (NPI 1487781514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487781514 NPI number — KRISTINE M MEYER-RUBADO MA, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEYER-RUBADO
Provider First Name:
KRISTINE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEYER
Provider Other First Name:
KRISTINE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LP, PLLC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1487781514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
975 34TH AVE NW
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-288-5818
Provider Business Mailing Address Fax Number:
507-424-1052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
975 34TH AVE NW
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-288-5818
Provider Business Practice Location Address Fax Number:
507-424-1052
Provider Enumeration Date:
02/27/2007

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: 103TC0700X , with the licence number:  LP3442 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X , with the licence number: LP3442 , 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: HP29916 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 921001022822 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 39P82ME . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 140013 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 158223200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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