Basic Information
| Provider Information | |||||||||
| NPI: | 1780995803 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRENDERGAST | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 UNIVERSITY AVE W STE 110N | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551142001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516025311 | ||||||||
| FaxNumber: | 6512226786 | ||||||||
| Practice Location | |||||||||
| Address1: | 910 E 26TH ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554044552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128846300 | ||||||||
| FaxNumber: | 6128846363 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2010 | ||||||||
| LastUpdateDate: | 10/28/2019 | ||||||||
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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 | 207V00000X | 61704 | MN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | A128699 | CA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 125-057-984 | IL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VX0201X | 61704 | MN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
No ID Information.