Audra Brown

Individual provider Active NPI Personal Care Attendant · Wayzata, MN

NPI 1750866331 · NPPES record last updated Sep 28, 2018

Key facts

NPI
1750866331
Entity type
Individual (NPI type 1)
Primary specialty
Personal Care Attendant 3747P1801X
License
1093903502 (MN)
Practice address
801 Twelve Oaks Center Dr Ste 822
Wayzata, MN 55391-4645
Phone
(952) 456-6561
Fax
(952) 456-6561
NPI assigned
Sep 28, 2018
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
1093903502MNMDPersonal Care Attendant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Personal Care Attendant
Group: 193400000X SINGLE SPECIALTY GROUP
3747P1801X 1093903502 MN Yes

Addresses

Primary practice location

801 Twelve Oaks Center Dr Ste 822
Wayzata, MN 55391-4645

Mailing address

801 Twelve Oaks Center Dr Ste 822
Wayzata, MN 55391-4645
Phone (952) 456-6561

Other providers in Wayzata, MN

All providers in Wayzata, MN · Personal Care Attendant in Minnesota

Sources for this page

Verify at the official NPI Registry.