Healthcare Provider Details

I. General information

NPI: 1811563984
Provider Name (Legal Business Name): ASHANTE LYNISE ALFORD STUDENT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2021
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SMITH AVE N
SAINT PAUL MN
55102-2344
US

IV. Provider business mailing address

333 SMITH AVE N
SAINT PAUL MN
55102-2344
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-8000
  • Fax:
Mailing address:
  • Phone: 651-241-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2495624
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: