Provider Demographics
NPI:1346061140
Name:NEALIS, RENAE (NP)
Entity type:Individual
Prefix:
First Name:RENAE
Middle Name:
Last Name:NEALIS
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:RENAE
Other - Middle Name:JENNIFER
Other - Last Name:TUFTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55480-0206
Mailing Address - Country:US
Mailing Address - Phone:612-262-9000
Mailing Address - Fax:
Practice Address - Street 1:2925 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1321
Practice Address - Country:US
Practice Address - Phone:612-863-4000
Practice Address - Fax:763-236-3026
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12366363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care