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General NPI Number Information
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NPI Number | 1144100728
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Entity Type | Individual
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Provider Name | MANJUN FENG
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Gender |
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 2450 RIVERSIDE AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55454-1450
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Country | US
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Telephone | 612-365-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 628 LAKE PINE DR
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City | SHOREVIEW
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State | MN
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Zip | 55126-1256
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Country | US
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Telephone | 651-356-9247
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 13225
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License Number State | MN
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