Provider Demographics
NPI:1992270763
Name:PRICE, ERNEST JOSEPH (STUDENT)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:JOSEPH
Last Name:PRICE
Suffix:
Gender:M
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 ROTH PL
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4411
Mailing Address - Country:US
Mailing Address - Phone:651-785-6615
Mailing Address - Fax:
Practice Address - Street 1:2300 ROTH PL
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-4411
Practice Address - Country:US
Practice Address - Phone:651-785-6615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty