1790485225 NPI number — LAURA JEAN AUSMUS PMHNP

Table of content: KATHARINE O WHITE MD (NPI 1770508723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790485225 NPI number — LAURA JEAN AUSMUS PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUSMUS
Provider First Name:
LAURA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
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:
1790485225
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25326 CROSS LAKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HINCKLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55037-5433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-385-0986
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3805 WASHINGTON AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55412-2141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-887-6282
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2023

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:  9988 , 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: 1891031209 . This is a "MSHO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1902344591. . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1891031209 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1902344591 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1902344591. . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1902344591. , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com