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NPI Code Detail

MEDICARE: BRIANNA LEE PANKRATZ APRN, CNP

MEDICARE: BRIANNA LEE PANKRATZ APRN, CNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner6741MN

General Provider Information

NPI Number : 1023661428
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIANNA LEE PANKRATZ APRN, CNP
Provider Business Mailing Address
First Line : 1900 SILVER LAKE RD NW
Second Line :
City : NEW BRIGHTON
State : MN
Zip : 55112-1786
Country : US
Telephone Number : 651-628-9566
Fax Number : 651-628-0411
Provider Business Practice Location Address
First Line : 1715 TOWER DR W STE 100
Second Line :
City : STILLWATER
State : MN
Zip : 55082-7609
Country : US
Telephone Number : 651-390-5001
Fax Number : 651-390-5002
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2019
Last Update Date : 02/12/2024

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