Basic Information
| Provider Information | |||||||||
| NPI: | 1023469749 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAYO CLINIC-ROCHESTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 249 HIGHWAY 63 N | ||||||||
| Address2: | |||||||||
| City: | RACINE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559678815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5072596828 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 1ST ST SW | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559050001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5072842511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2016 | ||||||||
| LastUpdateDate: | 06/23/2016 | ||||||||
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| AuthorizedOfficialLastName: | KIEHNE | ||||||||
| AuthorizedOfficialFirstName: | TRACY | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | ACUTE CARE NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 5072596828 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | A.C.N.P. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 120882-7 | MN | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.