Provider Demographics
NPI:1629838297
Name:PATRICK, EMILY ANNE (NP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE
Last Name:PATRICK
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 1:4730 CHICAGO AVE # MC26602G
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3570
Mailing Address - Country:US
Mailing Address - Phone:952-883-5793
Mailing Address - Fax:952-883-9600
Practice Address - Street 1:4730 CHICAGO AVE # MC26602G
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3570
Practice Address - Country:US
Practice Address - Phone:952-883-5793
Practice Address - Fax:952-883-9600
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15175-33363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology