1568152312 NPI number — STAY SPRY HEALTH

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 1568152312 NPI number — STAY SPRY HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAY SPRY HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KATEY SCHROEDER
Provider Other Organization Name Type Code:
5
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:
1568152312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5821 CEDAR LAKE RD S STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55416-1487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-293-0352
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5821 CEDAR LAKE RD S STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55416-1487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-293-0352
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHROEDER
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN ASSISTANT
Authorized Official Telephone Number:
612-963-1223

Provider Taxonomy Codes

  • Taxonomy code: 202D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1588830756 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1215267927 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".