1598045411 NPI number — MRS. RACHEL JO RIESGRAF MS, CGC

Table of content: MRS. RACHEL JO RIESGRAF MS, CGC (NPI 1598045411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598045411 NPI number — MRS. RACHEL JO RIESGRAF MS, CGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIESGRAF
Provider First Name:
RACHEL
Provider Middle Name:
JO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, CGC
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:
1598045411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1575 BEAM AVE
Provider Second Line Business Mailing Address:
HEALTH EAST ST. JOHN'S HOSPITAL
Provider Business Mailing Address City Name:
MAPLEWOOD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55109-1126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-232-7970
Provider Business Mailing Address Fax Number:
651-326-7050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1575 BEAM AVE
Provider Second Line Business Practice Location Address:
HEALTH EAST ST. JOHN'S HOSPITAL
Provider Business Practice Location Address City Name:
MAPLEWOOD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55109-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-232-7970
Provider Business Practice Location Address Fax Number:
651-326-7050
Provider Enumeration Date:
08/23/2011

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: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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