Provider Demographics
NPI:1720345705
Name:MCANELLY, JAMIE LYNNE (CPNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNNE
Last Name:MCANELLY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:17705 HUTCHINS DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345
Mailing Address - Country:US
Mailing Address - Phone:952-401-8300
Mailing Address - Fax:952-401-8240
Practice Address - Street 1:2530 CHICAGO AVE
Practice Address - Street 2:SUITE 550
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4289
Practice Address - Country:US
Practice Address - Phone:612-816-8000
Practice Address - Fax:612-813-8005
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2013-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR203760-2363LP0200X
MN556208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics