=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801970280
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY C RAYMOND MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2006
-----------------------------------------------------
Last Update Date | 01/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2312 S 6TH ST SUITE F256/2B WEST
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55454-1336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-273-8700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3989 CENTRAL AVE NE SUITE 300
-----------------------------------------------------
City | COLUMBIA HEIGHTS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55421-3900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-273-8700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 32219
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------