817 Marshall Ave

Primary specialty

Nursing Care AgencyTaxonomy code 251J00000X

License

R171403-6 Issued in MN

Legal business name

817 MARSHALL AVE

Practice address

817 Marshall Ave
Saint Paul, MN 55104-6651

Phone

(763) 202-8808

Fax

(651) 291-2739

NPI assigned

Aug 27, 2009

Last updated

Aug 27, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Channa Roxanne Pittman, RN

Title

Privte Duty Nurse

Phone

(763) 202-8808

Specialties & licenses 1

Addresses

Other names 1

• Key's To Best Health Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251331200000",
    "number": "1013140805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 MARSHALL AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551046651",
            "telephone_number": "763-202-8808",
            "fax_number": "651-291-2739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 MARSHALL AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551046651",
            "telephone_number": "763-202-8808",
            "fax_number": "651-291-2739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "817 MARSHALL AVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-27",
        "last_updated": "2009-08-27",
        "status": "A",
        "authorized_official_last_name": "PITTMAN",
        "authorized_official_first_name": "CHANNA",
        "authorized_official_middle_name": "ROXANNE",
        "authorized_official_title_or_position": "PRIVTE DUTY NURSE",
        "authorized_official_telephone_number": "763-202-8808",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "MN",
            "license": "R171403-6",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Key's To Best Health",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.