MEDICARE: GAIL A FELLMAN GNP

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	363L00000X	Nurse Practitioner	R1128703	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689648230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL A FELLMAN GNP

Provider Business Mailing Address
First Line	:	8170 33RD AVE S
Second Line	:	MC21110Q
City	:	BLOOMINGTON
State	:	MN
Zip	:	55425-4516
Country	:	US
Telephone Number	:	952-883-6805
Fax Number	:	952-883-6117

Provider Business Practice Location Address
First Line	:	8170 33RD AVE S
Second Line	:	MC21110Q
City	:	BLOOMINGTON
State	:	MN
Zip	:	55425-4516
Country	:	US
Telephone Number	:	952-883-6805
Fax Number	:	952-883-6117

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	04/16/2008

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