Provider Demographics
NPI:1962025924
Name:STREATER, MARY MONICA (APRN, CNM, RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MONICA
Last Name:STREATER
Suffix:
Gender:F
Credentials:APRN, CNM, RN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MONICA
Other - Last Name:GROGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, CNM, RN
Mailing Address - Street 1:606 24TH AVE S STE 300
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1437
Mailing Address - Country:US
Mailing Address - Phone:651-273-7111
Mailing Address - Fax:
Practice Address - Street 1:606 24TH AVE S STE 300
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1437
Practice Address - Country:US
Practice Address - Phone:612-273-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2465986163WM0102X
MN482367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn