Healthcare Provider Details

I. General information

NPI: 1104244987
Provider Name (Legal Business Name): LINDA REINEN-THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34307 HWY. 38
GRAND RAPIDS MN
55744
US

IV. Provider business mailing address

34307 HWY. 38
GRAND RAPIDS MN
55744
US

V. Phone/Fax

Practice location:
  • Phone: 218-327-4890
  • Fax:
Mailing address:
  • Phone: 218-327-4890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number1062728-1-AFC
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: