1609845833 NPI number — ALICIA J WOJCHIK N.P.

Table of content: ALICIA J WOJCHIK N.P. (NPI 1609845833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609845833 NPI number — ALICIA J WOJCHIK N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOJCHIK
Provider First Name:
ALICIA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MIKKONEN
Provider Other First Name:
ALICIA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609845833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110105 PIONEER TRL W
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
CHASKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55318-2680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-361-5800
Provider Business Mailing Address Fax Number:
952-361-5858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110105 PIONEER TRL W
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
CHASKA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55318-2680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-361-5800
Provider Business Practice Location Address Fax Number:
952-361-5858
Provider Enumeration Date:
03/17/2006

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: 363LA2200X , with the licence number:  R143499-2 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LG0600X , with the licence number: R143499-2 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1045995 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP58493 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 182268 . This is a "UCARE MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 331273900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41272700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0408045 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2406641 . This is a "AMERICA'S PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 611K5WO . This is a "BLUE CROSS BLUE SHIELD MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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