Healthcare Provider Details

I. General information

NPI: 1073678959
Provider Name (Legal Business Name): INDEPENDENT SCHOOL DISTRICT NO 2534
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SOUTH 9TH STREET
OLIVIA MN
56277
US

IV. Provider business mailing address

701 SOUTH 9TH STREET
OLIVIA MN
56277
US

V. Phone/Fax

Practice location:
  • Phone: 320-523-1031
  • Fax: 320-523-2399
Mailing address:
  • Phone: 320-523-1031
  • Fax: 320-523-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateMN

VIII. Authorized Official

Name: MRS. SUMMER RAE O'NEILL
Title or Position: BUSINESS MANAGER
Credential:
Phone: 320-523-1031