Healthcare Provider Details

I. General information

NPI: 1710969951
Provider Name (Legal Business Name): HEATHER ANNE NEUMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER ANNE MCKAY MD

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIR SUITE 1450
SAINT CLOUD MN
56303-5000
US

IV. Provider business mailing address

1900 CENTRACARE CIR SUITE 1450
SAINT CLOUD MN
56303-5000
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-4917
  • Fax: 320-229-5180
Mailing address:
  • Phone: 320-229-4917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40758
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: