Individual provider · NPI-1

Maya Bastian, CNP

Nurse Practitioner, Pediatrics · Eden Prairie, MN

NPI number1740799246
StatusActive
Last updated in NPPESSep 27, 2017

Details

NPI
1740799246
Entity type
Individual (NPI-1)
Name
Maya Bastian
Credential
CNP
Sex
Female
Sole proprietor
No
Enumeration date
Sep 27, 2017
Last updated
Sep 27, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LP0200X Nurse Practitioner, Pediatrics20172669MNYes

Practice location

12220 Travois Rd
Eden Prairie, MN 55347-4241

Phone 952-942-3803

Mailing address

12220 Travois Rd
Eden Prairie, MN 55347-4241

Phone 612-799-1793 · Fax 952-942-3803

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