1972649846 NPI number — MARY KATHERINE VERKENNES M.A. L.P.

Table of content: MARY KATHERINE VERKENNES M.A. L.P. (NPI 1972649846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972649846 NPI number — MARY KATHERINE VERKENNES M.A. L.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERKENNES
Provider First Name:
MARY
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
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:
1972649846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 777
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NISSWA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56468-0777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-963-2657
Provider Business Mailing Address Fax Number:
218-963-4692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25039 EAST CLARK LAKE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NISSWA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-963-2657
Provider Business Practice Location Address Fax Number:
218-963-4692
Provider Enumeration Date:
01/29/2007

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: 103TC1900X , with the licence number:  LP0386 , 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: 11806VE . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6235127 . This is a "MEDICA AND BHP PROVIDER #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 126422 . This is a "UCARE PROVIDER ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com