Healthcare Provider Details

I. General information

NPI: 1598332009
Provider Name (Legal Business Name): ERIC PRESSLEY RT (R)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 MEANDER CT
MEDINA MN
55340-4549
US

IV. Provider business mailing address

1255 NORTHLAND DR
SAINT PAUL MN
55120-1139
US

V. Phone/Fax

Practice location:
  • Phone: 763-560-0010
  • Fax:
Mailing address:
  • Phone: 651-687-0048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number312664
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: