Provider Demographics
NPI:1154356418
Name:GERMAIN, DEANNA (CNP)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:GERMAIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 NORTHDALE BLVD NW
Mailing Address - Street 2:#220 MEDICAL ADVANCED PAIN SPECIALISTS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55433
Mailing Address - Country:US
Mailing Address - Phone:763-537-6000
Mailing Address - Fax:763-537-6666
Practice Address - Street 1:9550 UPLAND LN N
Practice Address - Street 2:SUITE 100
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4481
Practice Address - Country:US
Practice Address - Phone:763-537-6000
Practice Address - Fax:763-537-6666
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0685933363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN856714000Medicaid
S77609Medicare UPIN
MN500002185Medicare ID - Type Unspecified