Provider Demographics
NPI:1003872540
Name:PLATT, ADRIENNE MILLIGAN (CPNP)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:MILLIGAN
Last Name:PLATT
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36974 BONNIE LAKES RD
Mailing Address - Street 2:
Mailing Address - City:CROSSLAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56442-3109
Mailing Address - Country:US
Mailing Address - Phone:816-835-0929
Mailing Address - Fax:
Practice Address - Street 1:36974 BONNIE LAKES RD
Practice Address - Street 2:
Practice Address - City:CROSSLAKE
Practice Address - State:MN
Practice Address - Zip Code:56442
Practice Address - Country:US
Practice Address - Phone:816-835-0929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002028643363LP0200X
TX140607363LP0200X
MN10170363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428969505Medicaid
269C401Medicare PIN