Provider Demographics
NPI:1578225355
Name:MEDHAUG, MCKINLEY HRUBY
Entity type:Individual
Prefix:
First Name:MCKINLEY
Middle Name:HRUBY
Last Name:MEDHAUG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 OAK GROVE ST APT 205
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3686
Mailing Address - Country:US
Mailing Address - Phone:651-968-7294
Mailing Address - Fax:
Practice Address - Street 1:430 OAK GROVE ST APT 205
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3686
Practice Address - Country:US
Practice Address - Phone:651-968-7294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-09
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty