Healthcare Provider Details

I. General information

NPI: 1003298308
Provider Name (Legal Business Name): RACHEL ANDERSON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 EXCELSIOR BLVD
ST LOUIS PARK MN
55416-4728
US

IV. Provider business mailing address

4201 EXCELSIOR BLVD
ST LOUIS PARK MN
55416-4728
US

V. Phone/Fax

Practice location:
  • Phone: 952-933-8900
  • Fax:
Mailing address:
  • Phone: 952-933-8900
  • Fax: 952-945-9536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP1397
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: