MEDICARE: PATRICIA CHINNAYA AMAJUOYI RN

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	163WH0200X	Home Health Registered Nurse	R 155321-3	MN
2	163W00000X	Registered Nurse	R 155321-3	MN

General Provider Information

NPI Number	:	1124232624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA CHINNAYA AMAJUOYI RN

Provider Business Mailing Address
First Line	:	1216 79TH AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55444-2006
Country	:	US
Telephone Number	:	763-503-3872
Fax Number	:

Provider Business Practice Location Address
First Line	:	2147 UNIVERSITY AVE W STE 214
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1327
Country	:	US
Telephone Number	:	651-647-9717
Fax Number	:

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	01/09/2012

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