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General NPI Number Information
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NPI Number | 1386758373
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Entity Type | Organization
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Legal Business Name | GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 200 UNIVERSITY AVE E
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City | SAINT PAUL
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State | MN
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Zip | 55101-2507
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Country | US
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Telephone | 651-726-2890
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Fax | 651-726-2848
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Provider Business Mailing Address
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Address Line | 200 UNIVERSITY AVE E # 010614
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City | SAINT PAUL
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State | MN
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Zip | 55101-2507
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Country | US
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Telephone | 651-325-2209
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Fax | 651-325-2221
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Authorized Official
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Title or Position | MANAGER PAYER RELATIONS AND STRATEG
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Name | VANESSA HARTZLER
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Credential |
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Telephone | 651-325-2209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | 262713
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License Number State | MN
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