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NPI Code Detail

MEDICARE: MS. REGINE W NDIFOR RN, BSN, MSN, FNP

MEDICARE: MS. REGINE W NDIFOR RN, BSN, MSN, FNP
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
1363LP2300XPrimary Care Nurse Practitioner209405-6MN

General Provider Information

NPI Number : 1538410287
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. REGINE W NDIFOR RN, BSN, MSN, FNP
Provider Business Mailing Address
First Line : 1415 LILAC DR N STE 190
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55422-4544
Country : US
Telephone Number : 763-267-8701
Fax Number : 763-231-9602
Provider Business Practice Location Address
First Line : 1415 LILAC DR N STE 190
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55422-4544
Country : US
Telephone Number : 763-267-8701
Fax Number : 763-231-9602
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2012
Last Update Date : 03/21/2018

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