Provider Demographics
NPI:1790880359
Name:DEPEW, CHARLOTTE KATHERINE (RN, CNP)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:KATHERINE
Last Name:DEPEW
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 JAMES AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1136
Mailing Address - Country:US
Mailing Address - Phone:612-925-3063
Mailing Address - Fax:
Practice Address - Street 1:1200 18TH ST E
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-3680
Practice Address - Country:US
Practice Address - Phone:651-438-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0601357363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health