Most Relevant Information
Provider Data
| NPI Number: | 1003368929 |
| Provider Name: | DIVINA FAMA BIKERI CNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | CNP 4854 |
Most Important Dates
| Enumeration Date: | 10/26/2016 |
| Last Updated: | 05/10/2017 |
Provider Practice Location
15245 BLUEBIRD ST NW
ANDOVER
MN
553043538
Practice Location Phone/Fax
| Phone: | 7635874688 |
| Fax: | 7635874662 |
Provider Mailing Location
8170 33RD AVE S
MS 21110Q
MINNEAPOLIS
MN
554254516
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |