Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | R1018172 | MN |
Y | 363LN0000X | Nurse Practitioner - Neonatal | R1018172 | MN |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | R1018172 | MN |
NPI | 1326103110 |
---|---|
Provider Name | Therese M Chenevert |
First Address | Bloomington, MN 55425-4516 |
Second Address | St Louis Park, MN 55426-4702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 09/04/2015 |