Healthcare Provider Details

I. General information

NPI: 1558430504
Provider Name (Legal Business Name): INDEPENDENT SCHOOL DISTRICT 255
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 1ST AVE SE
PINE ISLAND MN
55963
US

IV. Provider business mailing address

223 1ST AVE SE BOX 398
PINE ISLAND MN
55963
US

V. Phone/Fax

Practice location:
  • Phone: 507-356-4849
  • Fax: 507-356-8827
Mailing address:
  • Phone: 507-356-4849
  • Fax: 507-356-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. CAROL HEBL
Title or Position: BUSINESS MANAGER
Credential:
Phone: 507-356-4995