Healthcare Provider Details

I. General information

NPI: 1629216247
Provider Name (Legal Business Name): ELIZABETH JOHNSON EGGERS RATTNER APRN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 BLOOMINGTON AVE S
MINNEAPOLIS MN
55404-3089
US

IV. Provider business mailing address

2001 BLOOMINGTON AVE S
MINNEAPOLIS MN
55404-3089
US

V. Phone/Fax

Practice location:
  • Phone: 612-301-3433
  • Fax: 612-638-0685
Mailing address:
  • Phone: 612-301-3433
  • Fax: 612-638-0685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR1610596
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR1610596
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: