Provider Demographics
NPI:1598793366
Name:FADELL, MINDY CARLEEN (NP)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:CARLEEN
Last Name:FADELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS, MMC 484
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-626-2778
Mailing Address - Fax:612-626-2815
Practice Address - Street 1:424 HARVARD ST SE
Practice Address - Street 2:, FIRST FLOOR, SUITE M100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0362
Practice Address - Country:US
Practice Address - Phone:612-625-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 146946-2363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN12-03118OtherMEDICA CHOICE
MNHP49138OtherHEALTHPARTNERS
MN2298999OtherARAZ
MN12-09026OtherMEDICA PRIMARY
MN132557OtherUCARE
MN1042817OtherPREFERRED ONE
MT4304352Medicaid
MN132557OtherUCARE