Healthcare Provider Details

I. General information

NPI: 1942599006
Provider Name (Legal Business Name): ANNE ELIZABETH MASSEY DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 LYNDALE AVE S STE 105
RICHFIELD MN
55423-2673
US

IV. Provider business mailing address

6625 LYNDALE AVE S STE 300
MINNEAPOLIS MN
55423-2491
US

V. Phone/Fax

Practice location:
  • Phone: 612-788-8778
  • Fax: 612-869-3473
Mailing address:
  • Phone: 612-788-8778
  • Fax: 612-869-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number918
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5083
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006214
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number918
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: