Basic Information
| Provider Information | |||||||||
| NPI: | 1730193442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HYSER | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | RAE PAULSEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11134 N STATE ROAD 77 | ||||||||
| Address2: | DULUTH CLINIC HAYWARD | ||||||||
| City: | HAYWARD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156345505 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1885 PLAZA DR | ||||||||
| Address2: | |||||||||
| City: | EAGAN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551222979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529934001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 51958-20 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 48645 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 754473000 | 05 | MN | MEDICAID | P00438369 | 01 | RR MEDICARE PTAN | OTHER | 153H4PA | 01 | MN | BCBSMN | OTHER | 01-25342 | 01 | MN | MEDICA | OTHER |