Individual
MICHELLE MAUDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN,CNP
Contact information
Practice address
360 COLBORNE ST, SAINT PAUL, MN 55102-3228
(651) 767-8189
(651) 228-3649
Mailing address
360 COLBORNE ST, SAINT PAUL, MN 55102-3228
(651) 767-8380
(651) 228-3649
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R143864-2
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
246910300
—
MN
Enumeration date
05/19/2006
Last updated
10/13/2014
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