MEDICARE: CARRIE DIANE PARENTE MD

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	2084P0800X	Psychiatry Physician	46820	MN

General Provider Information

NPI Number	:	1992791651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE DIANE PARENTE MD

Provider Business Mailing Address
First Line	:	250 CENTRAL AVE N STE 114
Second Line	:
City	:	WAYZATA
State	:	MN
Zip	:	55391-1232
Country	:	US
Telephone Number	:	952-476-0783
Fax Number	:	952-487-0573

Provider Business Practice Location Address
First Line	:	250 CENTRAL AVE N STE 114
Second Line	:
City	:	WAYZATA
State	:	MN
Zip	:	55391-1232
Country	:	US
Telephone Number	:	952-476-0783
Fax Number	:	952-487-0573

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	05/03/2019

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