MEDICARE: FLORENCE K MCNERNEY RN CS LICSW

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	1041C0700X	Clinical Social Worker	546	MN
2	363LA2200X	Adult Health Nurse Practitioner	131221-01	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	111620	OTHER		U CARE

General Provider Information

NPI Number	:	1912995796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FLORENCE K MCNERNEY RN CS LICSW

Provider Business Mailing Address
First Line	:	3585 LEXINGTON AVE N
Second Line	:	#246
City	:	SAINT PAUL
State	:	MN
Zip	:	55126-8055
Country	:	US
Telephone Number	:	651-482-0164
Fax Number	:

Provider Business Practice Location Address
First Line	:	3585 LEXINGTON AVE N
Second Line	:	#246
City	:	SAINT PAUL
State	:	MN
Zip	:	55126-8055
Country	:	US
Telephone Number	:	651-482-0164
Fax Number	:

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	09/11/2025

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