Provider Demographics
NPI:1306032065
Name:MCNUTT, M E (NP)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:E
Last Name:MCNUTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2104 NORTHDALE BLVD NW
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-3028
Mailing Address - Country:US
Mailing Address - Phone:763-507-6000
Mailing Address - Fax:763-537-6666
Practice Address - Street 1:2104 NORTHDALE BLVD NW
Practice Address - Street 2:SUITE 220
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55433-3028
Practice Address - Country:US
Practice Address - Phone:763-507-6000
Practice Address - Fax:763-537-6666
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR-141583-0363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health