Healthcare Provider Details

I. General information

NPI: 1972893717
Provider Name (Legal Business Name): SILVIA BERNSTROM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SILVIA BERNSTROM

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 E FRANKLIN AVE
MINNEAPOLIS MN
55404-2157
US

IV. Provider business mailing address

324 E 35TH ST
MINNEAPOLIS MN
55408-4580
US

V. Phone/Fax

Practice location:
  • Phone: 612-871-3700
  • Fax: 612-871-3705
Mailing address:
  • Phone: 612-827-7181
  • Fax: 612-767-4545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6938
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number195462-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: