Healthcare Provider Details

I. General information

NPI: 1538136643
Provider Name (Legal Business Name): ANMARIE L. OPPEL PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12720 BASS LAKE RD
MAPLE GROVE MN
55369-6307
US

IV. Provider business mailing address

12720 BASS LAKE RD
MAPLE GROVE MN
55369-6307
US

V. Phone/Fax

Practice location:
  • Phone: 763-559-2861
  • Fax: 763-559-1338
Mailing address:
  • Phone: 763-559-2861
  • Fax: 763-559-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR 147533-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: