Healthcare Provider Details

I. General information

NPI: 1134017155
Provider Name (Legal Business Name): EMILY ANN WELTZIN-DECKER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY ANN WELTZIN

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-4000
  • Fax: 763-236-3026
Mailing address:
  • Phone: 612-262-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number13056
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: