Provider Demographics
NPI: | 1629252101 |
---|---|
Name: | PAULA ALLENBURG, LTD |
Entity Type: | Organization |
Organization Name: | PAULA ALLENBURG, LTD |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | PAULA |
Authorized Official - Middle Name: | ANDERSON |
Authorized Official - Last Name: | ALLENBURG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 612-872-9133 |
Mailing Address - Street 1: | 2415 EMERSON AVE S |
Mailing Address - Street 2: | |
Mailing Address - City: | MINNEAPOLIS |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55405-2602 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 612-872-9133 |
Mailing Address - Fax: | 612-872-0342 |
Practice Address - Street 1: | 2415 EMERSON AVE S |
Practice Address - Street 2: | |
Practice Address - City: | MINNEAPOLIS |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55405-2602 |
Practice Address - Country: | US |
Practice Address - Phone: | 612-872-9133 |
Practice Address - Fax: | 612-872-0342 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-12-20 |
Last Update Date: | 2007-12-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | 2467 | 261QM2500X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM2500X | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |