Healthcare Provider Details

I. General information

NPI: 1053065425
Provider Name (Legal Business Name): ADAM DUGGER BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CENTER ST W
ROCHESTER MN
55902-3003
US

IV. Provider business mailing address

816 SAINT JOSEPH ST APT 103
RAPID CITY SD
57701-2684
US

V. Phone/Fax

Practice location:
  • Phone: 507-266-7890
  • Fax:
Mailing address:
  • Phone: 618-889-7072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2496403
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: