1861817207 NPI number — PROFESSIONAL RESOURCE NETWORK, INC

Table of content: (NPI 1861817207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861817207 NPI number — PROFESSIONAL RESOURCE NETWORK, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL RESOURCE NETWORK, INC
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:
Provider Other Organization Name Type Code:
6
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:
1861817207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2740 AMERICAN BLVD W
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55431-1203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-858-8807
Provider Business Mailing Address Fax Number:
952-858-8835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 WATER ST W
Provider Second Line Business Practice Location Address:
SUITE 288
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55107-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-414-0063
Provider Business Practice Location Address Fax Number:
651-788-7508
Provider Enumeration Date:
02/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
DEVOLITES
Authorized Official First Name:
CHARIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
952-858-8807

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  1067063-1-CDT , 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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