1154345759 NPI number — ELIZABETH ANN ANKENY FNP-C

Table of content: ELIZABETH ANN ANKENY FNP-C (NPI 1154345759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154345759 NPI number — ELIZABETH ANN ANKENY FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANKENY
Provider First Name:
ELIZABETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154345759
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 4TH AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENWOOD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56334-1820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-634-4521
Provider Business Mailing Address Fax Number:
320-634-2262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 4TH AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENWOOD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56334-1820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-634-4521
Provider Business Practice Location Address Fax Number:
320-634-2262
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R164260-3 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01-21697 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01-21699 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132439 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2237466 . This is a "ARAZ" identifier . This identifiers is of the category "OTHER".
  • Identifier: 394G7AN . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: NA9331042389 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01-21693 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01-21698 . This is a "MEDICA CHOICE/SELECT" identifier . This identifiers is of the category "OTHER".




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