Provider Demographics
NPI:1578020525
Name:KVANLI, BRIANNA M (APRN, AGNP)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:M
Last Name:KVANLI
Suffix:
Gender:F
Credentials:APRN, AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 BROADWAY ST NE STE 300
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1761
Mailing Address - Country:US
Mailing Address - Phone:763-528-3414
Mailing Address - Fax:763-587-7069
Practice Address - Street 1:3433 BROADWAY ST NE STE 300
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1761
Practice Address - Country:US
Practice Address - Phone:763-528-3414
Practice Address - Fax:763-587-7069
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6460363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner