Provider Demographics
NPI:1659488625
Name:GENDRON, THOMAS JOSEPH (CNOR, OPA-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOSEPH
Last Name:GENDRON
Suffix:
Gender:M
Credentials:CNOR, OPA-C
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5650
Practice Address - Street 1:775 PRAIRIE CENTER DR
Practice Address - Street 2:SUITE 250
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7314
Practice Address - Country:US
Practice Address - Phone:952-944-2519
Practice Address - Fax:952-944-0460
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2022-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN1110737163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP49823OtherHEALTHPARTNERS
55A73GEOtherBLUE CROSS BLUE SHIELD
969991001287OtherPREFERREDONE