Individual
NANCY PICKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
715 E 78TH ST, HCMC WALMART RETAIL CLINIC-BLOOMINGTON, BLOOMINGTON, MN 55420-1397
(612) 873-7644
Mailing address
715 E 78TH ST, BLOOMINGTON, MN 55420-1397
(612) 873-7644
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R 112160-3
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101848
MEDICA
MN
01
—
233542500
MEDICAL ASSISTANCE
MN
01
—
262R1PI
BLUE CROSS BLUE SHIELD
MN
01
—
6982979
EVERCARE
MN
01
—
HP21020
HEALTHPARTNERS
MN
Enumeration date
08/08/2006
Last updated
04/23/2013
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