1639469455 NPI number — ELIZABETH ANN HUTTER-SEEBART APRN CNP

Table of content: ELIZABETH ANN HUTTER-SEEBART APRN CNP (NPI 1639469455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639469455 NPI number — ELIZABETH ANN HUTTER-SEEBART APRN CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUTTER-SEEBART
Provider First Name:
ELIZABETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN CNP
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:
1639469455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3366 OAKDALE AVENUE NORTH
Provider Second Line Business Mailing Address:
OAKDALE MEDICAL BUILDING, STE 605
Provider Business Mailing Address City Name:
ROBBINSDALE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-520-2940
Provider Business Mailing Address Fax Number:
763-520-2943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3366 OAKDALE AVE N
Provider Second Line Business Practice Location Address:
SUITE 605
Provider Business Practice Location Address City Name:
ROBBINSDALE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55422-2948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-520-2940
Provider Business Practice Location Address Fax Number:
763-520-2943
Provider Enumeration Date:
04/13/2011

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: 363LA2100X , with the licence number:  R 173691-7 , 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: 2011007749 . This is a "ANCC CERTIFICATION" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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