Basic Information
| Provider Information | |||||||||
| NPI: | 1801970280 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAYMOND | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3989 CENTRAL AVE NE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | COLUMBIA HEIGHTS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554213900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122738700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2312 S 6TH ST | ||||||||
| Address2: | SUITE F256/2B WEST | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554541336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122738700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 01/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 32219 | MN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 363283100 | 05 | MN | MEDICAID | 768316 | 01 | MN | ARAZ | OTHER | 15-39937 | 01 | MN | MEDICA PRIMARY | OTHER | 15-39937 | 01 | MN | MEDICA CHOICE | OTHER | HP22354 | 01 | MN | HEALTH PARTNERS | OTHER | 102823 | 01 | MN | UCARE | OTHER | 1009279 | 01 | MN | PREFERRED ONE | OTHER | 6D707RA | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER |