NPI |
1235218249 |
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Entity Type Code |
1 |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Last Name Legal Name |
NINOW |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider First Name |
PEGGY |
The city name in the location address of the provider being identified. |
Provider Middle Name |
L |
The State code in the location of the provider
being identified. |
Provider First Line Business Practice Location Address |
3800 PARK NICOLLET BLVD |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address City Name |
ST LOUIS PARK |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
MN |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Postal Code |
55416 |
The fax number associated with the location
address of the provider being identified. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Business Practice Location Address Telephone Number |
9529933117 |
The date that a record was last updated or changed. |
Provider Enumeration Date |
11/2/2006 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
7/8/2007 |
The date that a record was last updated or changed. |
Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
225X00000X |
The title or position of the authorized official. |
Provider License Number 1 |
100456 |
The 10-position telephone number of the authorized official. |
Provider License Number State Code 1 |
MN |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
N |
|