Provider Demographics
NPI:1396272159
Name:PINEIRO, ANGELICA MARIA (CNP)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARIA
Last Name:PINEIRO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3776 112TH LN NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-6620
Mailing Address - Country:US
Mailing Address - Phone:078-109-0074
Mailing Address - Fax:
Practice Address - Street 1:1068 LAKE ST S
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2639
Practice Address - Country:US
Practice Address - Phone:407-810-9007
Practice Address - Fax:651-982-6035
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1986343363LF0000X
MN5170363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1986343OtherREGISTERED NURSE LICENSE
MN5170OtherAPRN LICENSE
MN1396272159OtherNPI