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General NPI Number Information
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NPI Number | 1326027590
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Entity Type | Individual
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Provider Name | BEVERLY LYNN WOODBURY RN, CNP
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Gender | Female
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Dates
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Enumeration Date | 01/16/2006
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 401 CARLSON PARKWAY
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City | MINNETONKA
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State | MN
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Zip | 55305-5387
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Country | US
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Telephone | 952-992-3637
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Fax | 952-992-3039
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Provider Business Mailing Address
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Address Line | 7720 164TH LN NW
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City | ANOKA
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State | MN
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Zip | 55303-3560
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Country | US
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Telephone | 763-753-4242
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 290710-23
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License Number State | MD
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