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NPI Code Detail

MEDICARE: CORALIE ANN PEDERSON WHNP

MEDICARE: CORALIE ANN PEDERSON WHNP
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 Practitioner0011MN

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 : 1841283074
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORALIE ANN PEDERSON WHNP
Provider Business Mailing Address
First Line : 410 CHURCH ST SE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55455-0222
Country : US
Telephone Number : 612-625-8400
Fax Number : 612-677-3211
Provider Business Practice Location Address
First Line : 410 CHURCH ST SE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55455-0222
Country : US
Telephone Number : 612-625-8400
Fax Number : 612-677-3211
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2005
Last Update Date : 12/30/2025

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Directions to “ CORALIE ANN PEDERSON WHNP” Practice Location

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