Healthcare Provider Details

I. General information

NPI: 1821644774
Provider Name (Legal Business Name): DAVID BRANDSRUD PMHNP-BC, CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 WHITEWATER DR STE 101
MINNETONKA MN
55343-4157
US

IV. Provider business mailing address

12301 WHITEWATER DR STE 101
MINNETONKA MN
55343-4157
US

V. Phone/Fax

Practice location:
  • Phone: 952-999-6097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6832
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: