Healthcare Provider Details

I. General information

NPI: 1841477650
Provider Name (Legal Business Name): LORI A RANNEY CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 NORTH SMITH AVENUE
ST. PAUL MN
55102-2346
US

IV. Provider business mailing address

2910 CENTRE POINTE DRIVE, 35-121A
ROSEVILLE MN
55113-1182
US

V. Phone/Fax

Practice location:
  • Phone: 651-220-6732
  • Fax: 651-220-6005
Mailing address:
  • Phone: 651-855-2327
  • Fax: 651-855-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR1555693
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR1555693
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: