Healthcare Provider Details

I. General information

NPI: 1134212657
Provider Name (Legal Business Name): BONNIE ANN HATTEN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST STE 105
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

PO BOX 43
MINNEAPOLIS MN
55440-0043
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-0228
  • Fax: 612-863-0235
Mailing address:
  • Phone: 612-262-1166
  • Fax: 612-262-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number1066
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: