Healthcare Provider Details

I. General information

NPI: 1083063994
Provider Name (Legal Business Name): CAROL RIEGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 06/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5336 RUSSELL AVE N
BROOKLYN CENTER MN
55430-2950
US

IV. Provider business mailing address

5336 RUSSELL AVE N
BROOKLYN CENTER MN
55430-2950
US

V. Phone/Fax

Practice location:
  • Phone: 763-571-5588
  • Fax:
Mailing address:
  • Phone: 763-571-5588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberP94618200319
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: