Provider Demographics
NPI:1821302100
Name:PRUDHOMME, TOTIANNA RENEE (NP)
Entity Type:Individual
Prefix:
First Name:TOTIANNA
Middle Name:RENEE
Last Name:PRUDHOMME
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TOTIANNA
Other - Middle Name:
Other - Last Name:SCHLEGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7595 ANAGRAM DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7399
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:1560 BEAM AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1191
Practice Address - Country:US
Practice Address - Phone:651-779-7978
Practice Address - Fax:779-765-6612
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1716254363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care