Provider Demographics
NPI:1013988468
Name:ROHR, MABEL A (NP)
Entity Type:Individual
Prefix:
First Name:MABEL
Middle Name:A
Last Name:ROHR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVENUE SOUTH
Mailing Address - Street 2:MS 26602G
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-6805
Mailing Address - Fax:952-883-6117
Practice Address - Street 1:8170 33RD AVENUE SOUTH
Practice Address - Street 2:MS 26602G
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1672
Practice Address - Country:US
Practice Address - Phone:952-883-6805
Practice Address - Fax:952-883-6117
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0894012363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN998017200Medicaid
MN998017200Medicaid