Individual
MADISON BLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 LAGOON AVE, MINNEAPOLIS, MN 55408-2077
(612) 823-6300
Mailing address
1388 HUNTER SQ, WACONIA, MN 55387-1879
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
13273
MN
Other
Enumeration date
12/04/2025
Last updated
12/04/2025
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