Provider Demographics
NPI:1427562925
Name:FLATZ, RICHARD BRUCE
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:BRUCE
Last Name:FLATZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 WESTERN AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-4621
Mailing Address - Country:US
Mailing Address - Phone:612-240-5923
Mailing Address - Fax:
Practice Address - Street 1:14400 MARTIN DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-2031
Practice Address - Country:US
Practice Address - Phone:952-934-7554
Practice Address - Fax:952-934-7554
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN132523-4163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator