Healthcare Provider Details

I. General information

NPI: 1346284569
Provider Name (Legal Business Name): RUTH EMILY ANDERSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 NICOLLET MALL SUITE 600
MINNEAPOLIS MN
55403-2420
US

IV. Provider business mailing address

1221 NICOLLET MALL SUITE 600
MINNEAPOLIS MN
55403-2420
US

V. Phone/Fax

Practice location:
  • Phone: 612-573-2200
  • Fax: 612-573-2250
Mailing address:
  • Phone: 612-573-2200
  • Fax: 612-573-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0390177-21
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR 069318-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: