Healthcare Provider Details

I. General information

NPI: 1740199918
Provider Name (Legal Business Name): MICHAEL WARREN EIDE CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 GLENFIELD CT
EAGAN MN
55122-2156
US

IV. Provider business mailing address

1922 GLENFIELD CT
EAGAN MN
55122-2156
US

V. Phone/Fax

Practice location:
  • Phone: 701-429-0947
  • Fax:
Mailing address:
  • Phone: 701-429-0947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14759
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: