Active NPI
Corinne Dauksavage, ATC
- Prevention Professional
- Bemidji, MN
National Provider Identifier
1891227534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- 2135
- Practice address
- 1500 Birchmont Dr NE # 29
Bemidji, MN 56601-2600 - Phone
- (701) 866-9484
- NPI assigned
- Mar 31, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prevention Professional | 405300000X | 2135 | MN | Primary |
Addresses
Primary practice location
1500 Birchmont Dr NE # 29
Bemidji, MN 56601-2600
Mailing address
1500 Birchmont Dr NE # 29
Bemidji, MN 56601-2600
Phone (701) 866-9484
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2135 | MN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490918400000",
"number": "1891227534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 BIRCHMONT DR NE # 29",
"city": "BEMIDJI",
"state": "MN",
"postal_code": "566012600",
"telephone_number": "701-866-9484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 BIRCHMONT DR NE # 29",
"city": "BEMIDJI",
"state": "MN",
"postal_code": "566012600",
"telephone_number": "701-866-9484"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAUKSAVAGE",
"first_name": "CORINNE",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-31",
"last_updated": "2017-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "MN",
"license": "2135",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bemidji, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.