1972997328 NPI number — KATHERINE DUNSTAN ST. CYR PHARMD

Table of content: RAYMOND LOPEZ D.D.S. (NPI 1659439438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972997328 NPI number — KATHERINE DUNSTAN ST. CYR PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ST. CYR
Provider First Name:
KATHERINE
Provider Middle Name:
DUNSTAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
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:
1972997328
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4928 WILDROSE TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERMANTOWN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55811-3781
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-310-1464
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
927 TRETTEL LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLOQUET
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55720-1345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-878-2140
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2015

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: 183500000X , with the licence number:  121043 , 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)





Copyright © 2007-2025 www.npivalidator.com