MEDICARE: ANGANETTE MCBRYDE APRN CNS

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	R0875235	MN
2	364SP0807X	Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist	CNS 0046	MN

General Provider Information

NPI Number	:	1447236047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGANETTE MCBRYDE APRN CNS

Provider Business Mailing Address
First Line	:	8170 33RD AVE S
Second Line	:	PO BOX 1309 MAIL STOP 21110Q
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55425-4516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 PARK NICOLLET BLVD
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55416-2527
Country	:	US
Telephone Number	:	952-993-3307
Fax Number	:

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	03/04/2016

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