ERIN JOY DE LA BRUERE PA
Complete NPI Record 1619625639
Physician Assistant in Roseville, MN
Active since March 17, 2022PECOS Enrolled
100/100
CMS Quality Rating
Complete NPI Dataset
This page contains the complete raw NPPES record for Erin Joy De La Bruere, PA (NPI 1619625639), an individual physician assistant provider in Roseville, MN. All 29 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1619625639 Field 1/29
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 1 Field 2/29
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Provider Last Name Legal Name: DE LA BRUERE Field 3/29
- The last name of the provider. If the provider is an individual, this is the legal name.
- Provider First Name: ERIN Field 4/29
- The first name of the provider, if the provider is an individual.
- Provider Middle Name: JOY Field 5/29
- The middle name of the provider, if the provider is an individual.
- Provider Credential Text: PA Field 6/29
- The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
- Provider Other Last Name: FINNEY Field 7/29
- Other last name by which the provider being identified is or has been known.
- Provider Other First Name: ERIN Field 8/29
- Other first name by which the provider being identified is or has been known (if an individual). This may be the same as the "Provider first name" if the provider is or has been known by a different last name only.
- Provider Other Middle Name: JOY Field 9/29
- Other middle name by which the provider being identified is or has been known (if an individual). This may be the same as the "Provider middle name" if the provider is or has been known by a different last name only.
- Provider Other Last Name Type Code: 1 Field 10/29
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: 16333 E LAKE NETTA DR NE Field 11/29
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: HAM LAKE Field 12/29
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: MN Field 13/29
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 553045126 Field 14/29
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 15/29
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 6518957747 Field 16/29
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider First Line Business Practice Location Address: 2720 FAIRVIEW AVE N STE 200 Field 17/29
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: ROSEVILLE Field 18/29
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: MN Field 19/29
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 551131306 Field 20/29
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 21/29
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 6516636883 Field 22/29
- The telephone number associated with the location address of the provider being identified.
- Provider Gender Code: F Field 25/29
- The code designating the provider's gender if the provider is a person.
- Healthcare Provider Taxonomy Code 1: 363A00000X Field 26/29
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 27/29
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Sole Proprietor: Y Field 28/29
- Indicates whether the provider is registered as a sole proprietor. This is a single-character code: "Y" means the provider operates as a sole proprietor, and "N" means they do not.
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