Healthcare Provider Details

I. General information

NPI: 1134558588
Provider Name (Legal Business Name): VIRGEANA OLBERG X RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S 12TH ST SUITE 4710
MINNEAPOLIS MN
55404-1004
US

IV. Provider business mailing address

330 S 12TH ST SUITE 4710
MINNEAPOLIS MN
55404-1004
US

V. Phone/Fax

Practice location:
  • Phone: 612-348-4437
  • Fax: 612-632-8593
Mailing address:
  • Phone: 612-348-4437
  • Fax: 612-632-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR 79285-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: