Provider Demographics
NPI:1083772834
Name:CHMIELEWSKI, MARIA TERESA (CNS)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:TERESA
Last Name:CHMIELEWSKI
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 LAKE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1710
Mailing Address - Country:US
Mailing Address - Phone:651-999-6800
Mailing Address - Fax:651-999-6830
Practice Address - Street 1:6025 LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-999-6800
Practice Address - Fax:651-999-6830
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR141443-3364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN223641900Medicaid
MNQ42290Medicare UPIN