Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | R1403130 | MN |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 3059 | MN |
NPI | 1013109610 |
---|---|
Provider Name | Andrea L.j. Stephens |
First Address | Brooklyn Park, MN 55443-1400 |
Second Address | Brooklyn Park, MN 55443-1400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2007 |
Last Update Date | 10/11/2020 |