Basic Information
| Provider Information | |||||||||
| NPI: | 1700888211 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLUMENREICH | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | ESTELA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DULMAN | ||||||||
| OtherFirstName: | PATRICIA | ||||||||
| OtherMiddleName: | ESTELA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 540 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | WACONIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553871601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524424437 | ||||||||
| FaxNumber: | 9524423084 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | WACONIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553871601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524424437 | ||||||||
| FaxNumber: | 9524423084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2005 | ||||||||
| LastUpdateDate: | 02/19/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 38113 | MN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1524334 | 01 | MN | UBH MEDICA | OTHER | HP30289 | 01 | MN | HEALTH PARTNERS | OTHER | 1015941 | 01 | MN | PREFERRED ONE | OTHER | 737018100 | 05 | MN | MEDICAID | 121372 | 01 | MN | U CARE | OTHER | 82D10BL | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER |