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General NPI Number Information
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NPI Number | 1043182801
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Entity Type | Organization
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Legal Business Name | DOCTOR ETYANE AYANA
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Dates
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Enumeration Date | 09/22/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 1555 SOUTHCROSS DR W STE 208
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City | BURNSVILLE
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State | MN
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Zip | 55306-6938
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Country | US
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Telephone | 952-465-1959
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Fax | 952-236-0138
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Provider Business Mailing Address
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Address Line | 1555 SOUTHCROSS DR W STE 208
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City | BURNSVILLE
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State | MN
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Zip | 55306-6938
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Country | US
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Telephone | 952-236-4008
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Fax | 952-236-4008
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Authorized Official
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Title or Position | DO
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Name | ETYANE AYANA
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Credential |
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Telephone | 952-236-4008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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