MEDICARE: DAVID PEARSON

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
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1043606874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID PEARSON

Provider Business Mailing Address
First Line	:	3224 29TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2409
Country	:	US
Telephone Number	:	612-323-2012
Fax Number	:

Provider Business Practice Location Address
First Line	:	2512 W BROADWAY AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-1737
Country	:	US
Telephone Number	:	612-354-2629
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2015
Last Update Date	:	04/08/2015

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Directions to “ DAVID PEARSON ” Practice Location

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