Healthcare Provider Details

I. General information

NPI: 1487232187
Provider Name (Legal Business Name): FURTU SEIFEMICHAEL ANOTTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 LILAC DR N STE 190
GOLDEN VALLEY MN
55422-4544
US

IV. Provider business mailing address

1871 130TH LN NW
COON RAPIDS MN
55448-7059
US

V. Phone/Fax

Practice location:
  • Phone: 763-267-8701
  • Fax:
Mailing address:
  • Phone: 763-516-7420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07202221
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: