Healthcare Provider Details

I. General information

NPI: 1194658831
Provider Name (Legal Business Name): ANN ELIZABETH NIEDERMAYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

968 GRAND AVE
SAINT PAUL MN
55105-3014
US

IV. Provider business mailing address

1220 W 270TH ST
NEW PRAGUE MN
56071-9127
US

V. Phone/Fax

Practice location:
  • Phone: 651-895-2520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number660
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: