Healthcare Provider Details

I. General information

NPI: 1376873331
Provider Name (Legal Business Name): CRETILLI AND ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 EDGEWATER BLVD
MINNEAPOLIS MN
55417-2604
US

IV. Provider business mailing address

5430 EDGEWATER BLVD
MINNEAPOLIS MN
55417-2604
US

V. Phone/Fax

Practice location:
  • Phone: 612-822-2714
  • Fax:
Mailing address:
  • Phone: 612-822-2714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICIA K CRETILLI
Title or Position: PRESIDENT
Credential: RN, CNS, PHD
Phone: 612-822-2714