1588700702 NPI number — MRS. DEBRA C. ZINKEN MA, RN, CNP

Table of content: MRS. DEBRA C. ZINKEN MA, RN, CNP (NPI 1588700702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588700702 NPI number — MRS. DEBRA C. ZINKEN MA, RN, CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZINKEN
Provider First Name:
DEBRA
Provider Middle Name:
C.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, RN, CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHRISTIANSON
Provider Other First Name:
DEBRA
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588700702
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21370 JOHN MILLESS DR
Provider Second Line Business Mailing Address:
SUITE #210
Provider Business Mailing Address City Name:
ROGERS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55374-9449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-428-2288
Provider Business Mailing Address Fax Number:
763-428-2132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21370 JOHN MILLESS DR
Provider Second Line Business Practice Location Address:
SUITE #210
Provider Business Practice Location Address City Name:
ROGERS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55374-9449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-428-2288
Provider Business Practice Location Address Fax Number:
763-428-2132
Provider Enumeration Date:
01/29/2007

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: 363LP0808X , with the licence number:  R101756-8 , 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)





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