MEDICARE: TERI E. KAST RN, CNS, AOCNS

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	364SA2200X	Adult Health Clinical Nurse Specialist	R 109072-1	MN
2	364SX0200X	Oncology Clinical Nurse Specialist	R 109072-1	MN

General Provider Information

NPI Number	:	1710156781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERI E. KAST RN, CNS, AOCNS

Provider Business Mailing Address
First Line	:	420 DELAWARE ST SE
Second Line	:	MMC 200
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55455-0341
Country	:	US
Telephone Number	:	612-273-5396
Fax Number	:	612-273-5320

Provider Business Practice Location Address
First Line	:	420 DELAWARE ST SE
Second Line	:	MMC 200
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55455-0341
Country	:	US
Telephone Number	:	612-273-5396
Fax Number	:	612-273-5320

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

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/25/2008

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