Provider Demographics
NPI:1578251583
Name:DAUDT, CONNOR
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:DAUDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 EDWARD LN NE
Mailing Address - Street 2:
Mailing Address - City:LONGVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56655-3460
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:753 EDWARD LN NE
Practice Address - Street 2:
Practice Address - City:LONGVILLE
Practice Address - State:MN
Practice Address - Zip Code:56655-3460
Practice Address - Country:US
Practice Address - Phone:218-536-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program