Provider Demographics
NPI:1720075062
Name:WARNE, MARY ANN (RN, CNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:WARNE
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-1309
Mailing Address - Country:US
Mailing Address - Phone:952-883-7172
Mailing Address - Fax:952-853-8727
Practice Address - Street 1:2220 RIVERSIDE AVE
Practice Address - Street 2:MS 26602G
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1321
Practice Address - Country:US
Practice Address - Phone:952-883-6805
Practice Address - Fax:952-883-6117
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD212837-23363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN940818500Medicaid
MN940818500Medicaid
MN500002878Medicare ID - Type Unspecified