=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245940360
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE IRENE TRAXLER MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2022
-----------------------------------------------------
Last Update Date | 07/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5200 DOUGLAS DR N
-----------------------------------------------------
City | CRYSTAL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55429-3104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-290-1209
-----------------------------------------------------
Fax | 833-973-3527
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7517 BRISTOL VILLAGE CURV
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55438-2581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-301-4400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 031397-5
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------