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NPI Code Detail

MEDICARE: VICTORIA A EDDY ANP

MEDICARE:   VICTORIA A EDDY  ANP
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
1363L00000XNurse Practitioner0711098MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265404420
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTORIA A EDDY ANP
Provider Business Mailing Address
First Line : 401 PHALEN BLVD
Second Line : MC 41103F
City : SAINT PAUL
State : MN
Zip : 55130-5302
Country : US
Telephone Number : 651-254-7600
Fax Number : 651-254-7623
Provider Business Practice Location Address
First Line : 401 PHALEN BLVD
Second Line : MC 41103F
City : SAINT PAUL
State : MN
Zip : 55130-5302
Country : US
Telephone Number : 651-254-7600
Fax Number : 651-254-7623
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2006
Last Update Date : 07/19/2011

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Directions to “ VICTORIA A EDDY ANP” Practice Location

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