Individual
MRS. CHANON ESHA RIDORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
715 S 8TH ST, MINNEAPOLIS, MN 55404-1210
(612) 873-6963
Mailing address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-3000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2058
MN
363LP0200X
Pediatric Nurse Practitioner
Primary
2058
MN
363LP2300X
Primary Care Nurse Practitioner
2058
MN
Other
Enumeration date
01/07/2009
Last updated
08/06/2020
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