Provider Demographics
NPI:1841256831
Name:NIGHTINGALE, EDMUND JOSEPH (PHD)
Entity type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:JOSEPH
Last Name:NIGHTINGALE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 MARIE AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3884
Mailing Address - Country:US
Mailing Address - Phone:651-681-0500
Mailing Address - Fax:651-451-0064
Practice Address - Street 1:28 MARIE AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3884
Practice Address - Country:US
Practice Address - Phone:651-681-0500
Practice Address - Fax:651-451-0064
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 1545103TC0700X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical