Provider Demographics
NPI:1023469749
Name:MAYO CLINIC-ROCHESTER
Entity type:Organization
Organization Name:MAYO CLINIC-ROCHESTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUTE CARE NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KIEHNE
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP
Authorized Official - Phone:507-259-6828
Mailing Address - Street 1:249 HIGHWAY 63 N
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:MN
Mailing Address - Zip Code:55967-8815
Mailing Address - Country:US
Mailing Address - Phone:507-259-6828
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120882-7282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access