Healthcare Provider Details

I. General information

NPI: 1649562471
Provider Name (Legal Business Name): ELENA HENRIKSEN ZUPFER MD, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELENA JOANNA HENRIKSEN

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DELAWARE ST SE MMC 294
MINNEAPOLIS MN
55455-0341
US

IV. Provider business mailing address

420 DELAWARE ST SE MMC 294
MINNEAPOLIS MN
55455-0341
US

V. Phone/Fax

Practice location:
  • Phone: 612-624-9990
  • Fax:
Mailing address:
  • Phone: 612-624-9990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number59637
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: