Healthcare Provider Details

I. General information

NPI: 1033474267
Provider Name (Legal Business Name): PATIENT READINESS INSTUTUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5004 1/2 XERXES AVE S SUITE 3
MINNEAPOLIS MN
55410-2226
US

IV. Provider business mailing address

5004 1/2 XERXES AVE S SUITE 3
MINNEAPOLIS MN
55410-2226
US

V. Phone/Fax

Practice location:
  • Phone: 612-224-9913
  • Fax: 612-360-2993
Mailing address:
  • Phone: 612-224-9913
  • Fax: 612-360-2993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number37208
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number37208
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number37208
License Number StateMN

VIII. Authorized Official

Name: SAMMI M BOERNER
Title or Position: CARE COORDINATOR
Credential:
Phone: 612-224-9913