Individual
PATRICIA MACGILLIVRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
2525 CHICAGO AVE, 2525 CHICAGO AVENUE SOUTH, MINNEAPOLIS, MN 55404-4518
(612) 813-6107
(651) 855-2310
Mailing address
2525 CHICAGO AVENUE, 2525 CHICAGO AVENUE SOUTH, MINNEAPOLIS, MN 55404
(651) 855-2310
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R077250-3
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002218700
—
MN
Enumeration date
08/16/2005
Last updated
01/26/2016
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