Provider Demographics
NPI:1518539337
Name:NORD, ADDIE RACHEL (PA)
Entity type:Individual
Prefix:
First Name:ADDIE
Middle Name:RACHEL
Last Name:NORD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ADDIE
Other - Middle Name:RACHEL
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4344 WASHBURN AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-1020
Mailing Address - Country:US
Mailing Address - Phone:651-402-3305
Mailing Address - Fax:
Practice Address - Street 1:4040 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55433-4567
Practice Address - Country:US
Practice Address - Phone:763-427-9980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant