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General NPI Number Information
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NPI Number | 1225164494
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Entity Type | Individual
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Provider Name | DENINE&CHUCK KAY HELLENDRUNG
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Gender | Female
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Dates
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Enumeration Date | 02/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 64732 490TH ST
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City | FAIRFAX
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State | MN
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Zip | 55332-2078
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Country | US
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Telephone | 507-426-7314
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Fax |
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Provider Business Mailing Address
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Address Line | 64732 490TH ST
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City | FAIRFAX
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State | MN
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Zip | 55332-2078
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Country | US
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Telephone | 507-426-7314
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 1027930-3-CFC
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License Number State | MN
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