Healthcare Provider Details

I. General information

NPI: 1578146221
Provider Name (Legal Business Name): CORY A. MUONIO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 ELM ST E
ANNANDALE MN
55302-1109
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 320-274-3744
  • Fax: 320-274-8194
Mailing address:
  • Phone: 612-262-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8166
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: