Healthcare Provider Details

I. General information

NPI: 1043797848
Provider Name (Legal Business Name): NATALIE BRANDSRUD CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18205 45TH AVE N STE C
PLYMOUTH MN
55446-4594
US

IV. Provider business mailing address

11110 86TH AVE N
MAPLE GROVE MN
55369-4529
US

V. Phone/Fax

Practice location:
  • Phone: 763-400-7828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5954
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: