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NPI Code Detail

MEDICARE: BRYAN ANTHONY WAITS CNP

MEDICARE:   BRYAN ANTHONY WAITS  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
1363LA2200XAdult Health Nurse Practitioner13057MN
2363LA2100XAcute Care Nurse Practitioner13057MN

General Provider Information

NPI Number : 1245119163
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRYAN ANTHONY WAITS CNP
Provider Business Mailing Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-262-2233
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2025
Last Update Date : 12/12/2025

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Directions to “ BRYAN ANTHONY WAITS CNP” Practice Location

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