Individual
EDRA NORDSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
205 WABASHA ST S, SAINT PAUL, MN 55107-1805
(952) 967-5584
Mailing address
8170 33RD AVE S # MS 21110Q, MINNEAPOLIS, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
63394
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063823987
—
MN
Enumeration date
05/13/2014
Last updated
08/30/2018
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