Healthcare Provider Details

I. General information

NPI: 1508051673
Provider Name (Legal Business Name): DEBORAH MARY TWITO APRN-BC OR MS,RN,CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH M. TWITO APRN-BC OR MS,RN,CNS

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 CHICAGO AVE MEDICAL OFFICE BUILDING, SEVENTH FLOOR, SUITE 701
MINNEAPOLIS MN
55404-4522
US

IV. Provider business mailing address

2545 CHICAGO AVE MEDICAL OFFICE BUILDING, SEVENTH FLOOR, SUITE 701
MINNEAPOLIS MN
55404-4522
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-5327
  • Fax: 612-863-2596
Mailing address:
  • Phone: 651-645-7367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 090551-6
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number2007003348-01
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number0318
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: