Provider Demographics
NPI:1912995796
Name:MCNERNEY, FLORENCE K (RN CS LICSW)
Entity type:Individual
Prefix:
First Name:FLORENCE
Middle Name:K
Last Name:MCNERNEY
Suffix:
Gender:F
Credentials:RN CS LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3585 LEXINGTON AVE N
Mailing Address - Street 2:#246
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8055
Mailing Address - Country:US
Mailing Address - Phone:651-482-0164
Mailing Address - Fax:
Practice Address - Street 1:3585 LEXINGTON AVE N
Practice Address - Street 2:#246
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55126-8055
Practice Address - Country:US
Practice Address - Phone:651-482-0164
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5461041C0700X
MN131221-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
111620OtherU CARE
111620OtherU CARE