Provider Demographics
NPI:1538261581
Name:CERYES, NANCY JEAN (NP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:JEAN
Last Name:CERYES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:JEAN
Other - Last Name:CERYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14309 LENNELL DR
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-2316
Mailing Address - Country:US
Mailing Address - Phone:952-484-7736
Mailing Address - Fax:
Practice Address - Street 1:900 S 8TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1292
Practice Address - Country:US
Practice Address - Phone:612-873-6176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR160111-0363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner