Provider Demographics
NPI:1295926129
Name:MICHELLE A ALDRICH RN CNP PA
Entity type:Organization
Organization Name:MICHELLE A ALDRICH RN CNP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:612-306-2598
Mailing Address - Street 1:4215 31ST AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3311
Mailing Address - Country:US
Mailing Address - Phone:612-306-2598
Mailing Address - Fax:612-729-9453
Practice Address - Street 1:4215 31ST AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-3311
Practice Address - Country:US
Practice Address - Phone:612-306-2598
Practice Address - Fax:612-729-9453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 122978-3363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty