Provider Demographics
| NPI: | 1225751845 |
|---|---|
| Name: | MINNESOTA ONCOLOGY HEMATOLOGY PA |
| Entity type: | Organization |
| Organization Name: | MINNESOTA ONCOLOGY HEMATOLOGY PA |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CREDENTIALING COORDINATOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | CHRISTINE |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | WALKER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 651-602-5309 |
| Mailing Address - Street 1: | 2250 UNIVERSITY AVE W STE 110N |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SAINT PAUL |
| Mailing Address - State: | MN |
| Mailing Address - Zip Code: | 55114-1801 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 651-602-5309 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 2651 HILLCREST DR STE 105 |
| Practice Address - Street 2: | |
| Practice Address - City: | HUDSON |
| Practice Address - State: | WI |
| Practice Address - Zip Code: | 54016-4439 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 844-317-4673 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2022-09-20 |
| Last Update Date: | 2022-09-20 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
| No | 170300000X | Other Service Providers | Genetic Counselor, MS | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RH0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | Group - Multi-Specialty |
| No | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | Group - Multi-Specialty |
| No | 207VX0201X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | Group - Multi-Specialty |
| No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
| No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
| No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363LG0600X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | Group - Multi-Specialty |
