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General NPI Number Information
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NPI Number | 1891278693
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Entity Type | Individual
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Provider Name | SELASE ADZO AGUDU-MORGAN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/08/2018
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 19685 PILOT KNOB RD
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City | FARMINGTON
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State | MN
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Zip | 55024-7238
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Country | US
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Telephone | 651-602-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 8936 LYNDALE AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55420-2742
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Country | US
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Telephone | 952-881-0163
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2189783
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 6193
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License Number State | MN
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