Provider Demographics
NPI:1639288590
Name:NESTINGEN, SIGNE LEE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:SIGNE
Middle Name:LEE
Last Name:NESTINGEN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 COMO AVE # 203
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1718
Mailing Address - Country:US
Mailing Address - Phone:651-690-2667
Mailing Address - Fax:651-645-8026
Practice Address - Street 1:2301 COMO AVE # 203
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1718
Practice Address - Country:US
Practice Address - Phone:651-690-2667
Practice Address - Fax:651-645-8026
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1544103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6281969OtherMEDICA
MN34289OtherHEALTH PARTNERS
MN12917NEOtherBLUE CROSS BLUE SHIELD
MN680001454Medicare PIN