Individual
CORINNE FANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6401 FRANCE AVE S, EDINA, MN 55435-2104
(952) 924-5000
Mailing address
4039 41ST AVE S, MINNEAPOLIS, MN 55406-3419
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
12448
MN
Other
Enumeration date
01/08/2025
Last updated
01/13/2025
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