Provider Demographics
NPI:1477232551
Name:LAWSON ZANKLI, NADU MADJE
Entity Type:Individual
Prefix:
First Name:NADU
Middle Name:MADJE
Last Name:LAWSON ZANKLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 ASH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-1013
Mailing Address - Country:US
Mailing Address - Phone:763-439-3157
Mailing Address - Fax:
Practice Address - Street 1:7901 BASS LAKE RD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55428-3105
Practice Address - Country:US
Practice Address - Phone:763-257-0130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNF06231870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily