Healthcare Provider Details

I. General information

NPI: 1306000716
Provider Name (Legal Business Name): KAREN ANN BREZINKA NCTMB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W 84TH ST
BLOOMINGTON MN
55431-1602
US

IV. Provider business mailing address

5115 11TH AVE S
MINNEAPOLIS MN
55417-1827
US

V. Phone/Fax

Practice location:
  • Phone: 952-885-5465
  • Fax: 952-888-1957
Mailing address:
  • Phone: 952-885-5465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: