Healthcare Provider Details

I. General information

NPI: 1316078264
Provider Name (Legal Business Name): DONNA BARTOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1953 UNIVERSITY AVE W
SAINT PAUL MN
55104-3427
US

IV. Provider business mailing address

W9907 619TH AVE
ELLSWORTH WI
54011
US

V. Phone/Fax

Practice location:
  • Phone: 651-659-0208
  • Fax: 651-659-0161
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR 170234-9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: