Healthcare Provider Details

I. General information

NPI: 1477300556
Provider Name (Legal Business Name): EMILIE HAASE WARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILIE WARD

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 JACKSON ST
SAINT PAUL MN
55101-2502
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 651-495-6600
  • Fax: 651-254-3123
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11794
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number11794
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2077387
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: