Provider Demographics
NPI:1437233525
Name:MAKI SETRE, MARY L (CNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:MAKI SETRE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 FRANCE AVENUE SOUTH
Mailing Address - Street 2:SUITE 540
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-927-4045
Mailing Address - Fax:952-924-4133
Practice Address - Street 1:6545 FRANCE AVENUE SOUTH
Practice Address - Street 2:SUITE 540
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-927-4045
Practice Address - Fax:952-924-4133
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0639471363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0701329OtherMEDICA
MN39D23MAOtherBC/BS OF MINNESOTA