Healthcare Provider Details

I. General information

NPI: 1235360272
Provider Name (Legal Business Name): STEPHANIE LYNN SEUBERT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE LYNN PINNOW RN

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S 12TH ST SUITE 4710, MC 635
MINNEAPOLIS MN
55404-1004
US

IV. Provider business mailing address

330 S 12TH ST SUITE 4710, MC 635
MINNEAPOLIS MN
55404-1004
US

V. Phone/Fax

Practice location:
  • Phone: 612-596-7067
  • Fax: 612-466-9652
Mailing address:
  • Phone: 612-596-7067
  • Fax: 612-466-9652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR 79245-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: