Healthcare Provider Details

I. General information

NPI: 1154345759
Provider Name (Legal Business Name): ELIZABETH ANN ANKENY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 4TH AVE SE
GLENWOOD MN
56334-1820
US

IV. Provider business mailing address

10 4TH AVE SE
GLENWOOD MN
56334-1820
US

V. Phone/Fax

Practice location:
  • Phone: 320-634-4521
  • Fax: 320-634-2262
Mailing address:
  • Phone: 320-634-4521
  • Fax: 320-634-2262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR164260-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: