MEDICARE: ANCINETTA FRANCES CALDWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1225668999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANCINETTA FRANCES CALDWELL

Provider Business Mailing Address
First Line	:	1730 PENN AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-3054
Country	:	US
Telephone Number	:	612-478-0804
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 PENN AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-3054
Country	:	US
Telephone Number	:	612-478-0804
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2020
Last Update Date	:	01/22/2020

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