MEDICARE: COMPASSIONATE NURSES NETWORK LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1962833483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE NURSES NETWORK LLC

Provider Business Mailing Address
First Line	:	1419 PENN AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-3049
Country	:	US
Telephone Number	:	612-522-5232
Fax Number	:

Provider Business Practice Location Address
First Line	:	1419 PENN AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-3049
Country	:	US
Telephone Number	:	612-522-5232
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SAUNDRA LYNN MCKISSIC
Credential	:	RN
Telephone Number	:	612-522-5232

Provider Enumeration Date	:	12/09/2013
Last Update Date	:	12/09/2013

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