Healthcare Provider Details

I. General information

NPI: 1619942281
Provider Name (Legal Business Name): PATRICIA A OPAL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 34TH AVENUE SOUTH MS 26602G
MINNEAPOLIS MN
55425-4516
US

IV. Provider business mailing address

1055 WESTGATE DR STE 1000
SAINT PAUL MN
55114-1065
US

V. Phone/Fax

Practice location:
  • Phone: 952-883-6805
  • Fax: 952-883-6117
Mailing address:
  • Phone: 612-262-7800
  • Fax: 612-262-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR1372740
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0847
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: