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General NPI Number Information
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NPI Number | 1710935655
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Entity Type | Individual
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Provider Name | CONSTANCE A ADKISSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 08/31/2011
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Provider Practice Location Address
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Address Line | 701 PARK AVE HCMC G-7
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City | MINNEAPOLIS
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State | MN
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Zip | 55415-1623
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Country | US
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Telephone | 612-873-2686
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Fax |
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Provider Business Mailing Address
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Address Line | 914 S 8TH ST S6
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-1210
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Country | US
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Telephone | 612-347-5954
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Fax | 612-373-1886
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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 | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 36452
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License Number State | MN
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