Healthcare Provider Details

I. General information

NPI: 1538136155
Provider Name (Legal Business Name): LINDA ANN BERNTSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 WASHINGTON AVE N # 5000
MINNEAPOLIS MN
55401-1377
US

IV. Provider business mailing address

305 E RIVER PKWY
CHAMPLIN MN
55316-1421
US

V. Phone/Fax

Practice location:
  • Phone: 612-659-7111
  • Fax: 612-659-7101
Mailing address:
  • Phone: 763-439-0515
  • Fax: 612-659-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR 083077-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: