MEDICARE: MS. NANCY GAIL LUDWIG MA, LP

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	103TC0700X	Clinical Psychologist	LP3548	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15F49LU	OTHER	MN	BCBS OF MN
2	HP26421	OTHER	MN	HEALTH PARTNERS

General Provider Information

NPI Number	:	1811059959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY GAIL LUDWIG MA, LP

Provider Business Mailing Address
First Line	:	6090 117TH ST N
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-5725
Country	:	US
Telephone Number	:	651-402-4145
Fax Number	:

Provider Business Practice Location Address
First Line	:	3570 LEXINGTON AVE N
Second Line	:	SUITE 100
City	:	SHOREVIEW
State	:	MN
Zip	:	55126-8049
Country	:	US
Telephone Number	:	651-481-0664
Fax Number	:

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/08/2007

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