1912941493 NPI number — DONNA CLAYPOOL N.P.

Table of content: DONNA CLAYPOOL N.P. (NPI 1912941493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912941493 NPI number — DONNA CLAYPOOL N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLAYPOOL
Provider First Name:
DONNA
Provider Middle Name:
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:
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:
1912941493
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
318 EAST MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROSBY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56441-1645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-546-8375
Provider Business Mailing Address Fax Number:
218-546-4400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
318 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROSBY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56441-1645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-546-8375
Provider Business Practice Location Address Fax Number:
218-546-4400
Provider Enumeration Date:
06/15/2006

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: 363LX0001X , with the licence number:  R9744042 , 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: HP22957 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0700916 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 111081 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 946815300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: A013 . This is a "TRIWEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 43848900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1011860 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 32T86CL . This is a "BCBSM" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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