Basic Information
Provider Information
NPI: 1134152879
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CABRERA
FirstName: CHRISTINE
MiddleName: LYNN
NamePrefix:  
NameSuffix:  
Credential: M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 712 S CASCADE ST
Address2:  
City: FERGUS FALLS
State: MN
PostalCode: 565372913
CountryCode: US
TelephoneNumber: 2187368000
FaxNumber: 2187396718
Practice Location
Address1: 712 S CASCADE ST
Address2:  
City: FERGUS FALLS
State: MN
PostalCode: 565372913
CountryCode: US
TelephoneNumber: 2187368000
FaxNumber: 2187396718
Other Information
ProviderEnumerationDate: 07/08/2006
LastUpdateDate: 03/30/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/30/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X18021NDN Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000XA84448CAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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