Provider Demographics
NPI:1962474015
Name:SCHWANKE, MARY J (PNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:SCHWANKE
Suffix:
Gender:F
Credentials:PNP
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:651-647-2075
Practice Address - Street 1:451 NORTH DUNLAP ST - MAIL STOP 32700A
Practice Address - Street 2:HEALTHPARTNERS MIDWAY CLINIC
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4621
Practice Address - Country:US
Practice Address - Phone:651-647-2200
Practice Address - Fax:651-647-2075
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2011-12-15
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Provider Licenses
StateLicense IDTaxonomies
MN0659914363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN371542600Medicaid
MN371542600Medicaid
500001253Medicare ID - Type Unspecified