MEDICARE: HEALTH EMPOWERMENT INSTITUTE

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	363LW0102X	Women's Health Nurse Practitioner	R112760-7	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C05962	OTHER	MN	PTAN

General Provider Information

NPI Number	:	1831328756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH EMPOWERMENT INSTITUTE

Provider Business Mailing Address
First Line	:	2512 W BROADWAY AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-1737
Country	:	US
Telephone Number	:	612-354-2629
Fax Number	:	612-354-2740

Provider Business Practice Location Address
First Line	:	2512 W BROADWAY AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-1737
Country	:	US
Telephone Number	:	612-354-2629
Fax Number	:	612-354-2740

Authorized Official
Title or Position	:	CENTER DIRECTOR
Name	:	MS. PANDORA LEE WHITE
Credential	:	CNP
Telephone Number	:	61223542629

Provider Enumeration Date	:	07/13/2009
Last Update Date	:	12/18/2014

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