Healthcare Provider Details

I. General information

NPI: 1194167643
Provider Name (Legal Business Name): MURIEL DENISE PHILIPP CNP, MA, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 FORD RD SUITE B
ST LOUIS PARK MN
55426-1099
US

IV. Provider business mailing address

1155 FORD RD SUITE B
ST LOUIS PARK MN
55426-1099
US

V. Phone/Fax

Practice location:
  • Phone: 952-378-1800
  • Fax: 952-378-1714
Mailing address:
  • Phone: 952-378-1800
  • Fax: 952-378-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR091756-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: