Basic Information
| Provider Information | |||||||||
| NPI: | 1407946866 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KONSTANTINIDES | ||||||||
| FirstName: | NANCY | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| Address2: | 420 DELAWARE ST SE MMC 494 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122736700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 HARVARD ST SE | ||||||||
| Address2: | RADIATION ONCOLOGY CLINIC | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554550363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122736700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 02/27/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | R-0950435 | MN | N | Nursing Service Providers | Licensed Practical Nurse | 363L00000X | R-0950435 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 4306219 | 05 | MT | MEDICAID | 41263800 | 05 | MN | MEDICAID | B631 | 01 | CHAMPUS | OTHER | 135262 | 01 | MN | UCARE | OTHER | 2386131 | 01 | MN | AMERICA'S PPO | OTHER | 1044945 | 01 | MN | PREFERRED ONE | OTHER | 426M0KO | 01 | MN | BCBS | OTHER | HP55785 | 01 | MN | HEALTH PARTNERS | OTHER |