Healthcare Provider Details

I. General information

NPI: 1699153551
Provider Name (Legal Business Name): JUSTINE TRUMM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 HELMO AVE N STE 100
OAKDALE MN
55128-6034
US

IV. Provider business mailing address

1414 MARYLAND AVE E
SAINT PAUL MN
55106-2824
US

V. Phone/Fax

Practice location:
  • Phone: 651-326-5300
  • Fax:
Mailing address:
  • Phone: 651-772-3461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number60944
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: