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General NPI Number Information
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NPI Number | 1417418120
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Entity Type | Individual
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Provider Name | CLAIRE M MACCANI
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Gender | Female
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 03/26/2019
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Provider Practice Location Address
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Address Line | 909 FULTON ST SE FL 4
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City | MINNEAPOLIS
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State | MN
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Zip | 55455-4800
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Country | US
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Telephone | 612-676-5008
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Fax |
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Provider Business Mailing Address
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Address Line | 6612 UPTON AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55423-1907
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Country | US
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Telephone | 952-261-9376
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 12951
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License Number State | MN
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