1891835229 NPI number — MS. CYNTHIA RUTH PRATT M.A., L.P.

Table of content: MS. CYNTHIA RUTH PRATT M.A., L.P. (NPI 1891835229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891835229 NPI number — MS. CYNTHIA RUTH PRATT M.A., L.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRATT
Provider First Name:
CYNTHIA
Provider Middle Name:
RUTH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., L.P.
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:
1891835229
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6668
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55406-0668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-721-6886
Provider Business Mailing Address Fax Number:
612-721-2832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
821 RAYMOND AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55114-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-721-6886
Provider Business Practice Location Address Fax Number:
612-721-2832
Provider Enumeration Date:
02/07/2007

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: 103T00000X , with the licence number:  3495 , 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: 060T7NO . This is a "BLUE CROSS BLUE SHILD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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