Healthcare Provider Details

I. General information

NPI: 1912118522
Provider Name (Legal Business Name): BERNADETTE KIM QUADLING MBBCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 7TH ST W
SAINT PAUL MN
55102-3828
US

IV. Provider business mailing address

1026 7TH ST W
SAINT PAUL MN
55102-3828
US

V. Phone/Fax

Practice location:
  • Phone: 651-758-9413
  • Fax:
Mailing address:
  • Phone: 651-758-9413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number49593
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: