Provider Demographics
NPI:1861401747
Name:LOMNICKI, PATRICIA ANN (RN, CNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:LOMNICKI
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2190 ST. CROIX AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 CARLSON PKWY
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5359
Practice Address - Country:US
Practice Address - Phone:952-992-3581
Practice Address - Fax:952-992-3039
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR114712-4363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6543162-00Medicaid
MN500002857Medicare ID - Type Unspecified
MNR96550Medicare UPIN