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General NPI Number Information
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NPI Number | 1407865223
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Entity Type | Individual
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Provider Name | NANCY PICKETT
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Gender | Female
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 04/23/2013
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Provider Practice Location Address
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Address Line | 715 E 78TH ST HCMC WALMART RETAIL CLINIC-BLOOMINGTON
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City | BLOOMINGTON
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State | MN
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Zip | 55420-1397
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Country | US
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Telephone | 612-873-7644
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Fax |
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Provider Business Mailing Address
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Address Line | 715 E 78TH ST
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City | BLOOMINGTON
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State | MN
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Zip | 55420-1397
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Country | US
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Telephone | 612-873-7644
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R 112160-3
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License Number State | MN
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