Healthcare Provider Details

I. General information

NPI: 1750610523
Provider Name (Legal Business Name): ALAYNA CLAIRE PINE C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 24TH AVE S SUITE 700
MINNEAPOLIS MN
55454-1455
US

IV. Provider business mailing address

606 24TH AVE S SUITE 700
MINNEAPOLIS MN
55454-1455
US

V. Phone/Fax

Practice location:
  • Phone: 612-672-2450
  • Fax: 612-672-2451
Mailing address:
  • Phone: 612-672-2450
  • Fax: 612-672-2451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.10939
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA10939NP
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2164847
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: