Healthcare Provider Details

I. General information

NPI: 1952121253
Provider Name (Legal Business Name): ADRIENNE JO AASAND CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 BEAM AVE
MAPLEWOOD MN
55109-1127
US

IV. Provider business mailing address

N6387 1307TH ST
PRESCOTT WI
54021-7022
US

V. Phone/Fax

Practice location:
  • Phone: 651-779-7978
  • Fax:
Mailing address:
  • Phone: 763-458-4649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number16049-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number16049-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number12169
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number12169
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: