Healthcare Provider Details

I. General information

NPI: 1265117022
Provider Name (Legal Business Name): ABBY VLASATY DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBY MANITZ

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 UNIVERSITY AVE W
SAINT PAUL MN
55104-4001
US

IV. Provider business mailing address

1390 UNIVERSITY AVE W
SAINT PAUL MN
55104-4001
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10401
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: