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General NPI Number Information
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NPI Number | 1538481684
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Entity Type | Organization
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Legal Business Name | TRINITY INTEGRATIVE MEDICINE PA
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Dates
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Enumeration Date | 02/17/2010
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 2434 E 117TH ST
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City | BURNSVILLE
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State | MN
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Zip | 55337-1269
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Country | US
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Telephone | 612-875-7627
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Fax |
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Provider Business Mailing Address
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Address Line | 10935 TERRITORIAL DR
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City | BURNSVILLE
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State | MN
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Zip | 55337-1156
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Country | US
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Telephone | 612-875-7627
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BERNARDA M ZENKER
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Credential | M.D.
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Telephone | 612-875-7627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 42380
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License Number State | MN
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