Provider Demographics
NPI:1568228120
Name:MACKINNON, ANNE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:MACKINNON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:BERNU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4412 W 58TH ST
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1621
Mailing Address - Country:US
Mailing Address - Phone:612-940-6174
Mailing Address - Fax:
Practice Address - Street 1:6405 FRANCE AVE S STE W200
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2186
Practice Address - Country:US
Practice Address - Phone:952-365-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner