Provider Demographics
NPI:1831251248
Name:KLINGER, VIRGINIA ANNETTE
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:ANNETTE
Last Name:KLINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33545 LILAC TRL
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:MN
Mailing Address - Zip Code:56443-5139
Mailing Address - Country:US
Mailing Address - Phone:320-594-2404
Mailing Address - Fax:320-594-2404
Practice Address - Street 1:33545 LILAC TRL
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:MN
Practice Address - Zip Code:56443-5139
Practice Address - Country:US
Practice Address - Phone:320-594-2404
Practice Address - Fax:320-594-2404
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor