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General NPI Number Information
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NPI Number | 1023469749
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Entity Type | Organization
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Legal Business Name | MAYO CLINIC-ROCHESTER
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 200 1ST ST SW
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City | ROCHESTER
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State | MN
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Zip | 55905-0001
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Country | US
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Telephone | 507-284-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 249 HIGHWAY 63 N
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City | RACINE
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State | MN
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Zip | 55967-8815
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Country | US
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Telephone | 507-259-6828
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Fax |
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Authorized Official
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Title or Position | ACUTE CARE NURSE PRACTITIONER
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Name | TRACY LYNN KIEHNE
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Credential | A.C.N.P.
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Telephone | 507-259-6828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 120882-7
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License Number State | MN
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