Healthcare Provider Details

I. General information

NPI: 1790880359
Provider Name (Legal Business Name): CHARLOTTE KATHERINE DEPEW RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 18TH ST E
HASTINGS MN
55033-3680
US

IV. Provider business mailing address

5201 JAMES AVE S
MINNEAPOLIS MN
55419-1136
US

V. Phone/Fax

Practice location:
  • Phone: 651-438-8500
  • Fax:
Mailing address:
  • Phone: 612-925-3063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR0601357
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: