=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689954026
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAOMI L. BERENDS APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2011
-----------------------------------------------------
Last Update Date | 04/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4194 LEXINGTON AVE N
-----------------------------------------------------
City | SHOREVIEW
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55126-6106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-483-5461
-----------------------------------------------------
Fax | 316-689-9769
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2925 CHICAGO AVE
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55407-1321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-262-9000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 12294
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 53-75580
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------