Provider Demographics
NPI:1750610523
Name:PINE, ALAYNA CLAIRE (CNP)
Entity type:Individual
Prefix:
First Name:ALAYNA
Middle Name:CLAIRE
Last Name:PINE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:606 24TH AVE S
Mailing Address - Street 2:SUITE 700
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1455
Mailing Address - Country:US
Mailing Address - Phone:612-672-2450
Mailing Address - Fax:612-672-2451
Practice Address - Street 1:606 24TH AVE S
Practice Address - Street 2:SUITE 700
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1455
Practice Address - Country:US
Practice Address - Phone:612-672-2450
Practice Address - Fax:612-672-2451
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHCOA.10939363LF0000X
OHCOA10939NP363LF0000X
MN2164847363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3040846Medicaid
NP33541Medicare PIN