MEDICARE: NADINE EMERSON L.P.

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	103T00000X	Psychologist	LP 1041	MN

General Provider Information

NPI Number	:	1972714764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADINE EMERSON L.P.

Provider Business Mailing Address
First Line	:	1422 W LAKE ST
Second Line	:	SUITE 204
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2616
Country	:	US
Telephone Number	:	612-822-7135
Fax Number	:

Provider Business Practice Location Address
First Line	:	1422 W LAKE ST
Second Line	:	SUITE 204
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2616
Country	:	US
Telephone Number	:	612-822-7135
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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