| Organization Name: | PAIN INJURY AND BRAIN CENTERS OF AMERICA LLC |
| NPI Number: | 1912287038 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HAL KENNER (CLINICIAN) |
| Mailing Address: | 4465 Highway 61 Goodview |
| State: | MN US |
| Postal Code: | 559871659 |
| Phone Number: | 5074101144 |
| Fax Number: | 5074101144 |
| NPI Enumeration Date: | 08/20/2011 |
| NPI Last Update Date: | 08/20/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163W00000X |
| License Number: | R134470-7 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or a Bachelor of Science degree in nursing (B.S.N.), who is licensed or certified by the state, and is practicing within the scope of that license or certification. R.N. |