Active NPI
Mary Anne Elder, FNP-C
- Family Nurse Practitioner
- Minneapolis, MN
National Provider Identifier
1689634677
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- R1176072
- Practice address
- 825 Nicollet Mall
Suite 1149
Minneapolis, MN 55402-2606 - Phone
- (612) 338-3333
- Fax
- (612) 349-3838
- NPI assigned
- Mar 24, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R1176072 | MN | Primary |
Addresses
Primary practice location
825 Nicollet Mall
Suite 1149
Minneapolis, MN 55402-2606
Mailing address
825 Nicollet Mall
Suite 1149
Minneapolis, MN 55402-2606
Phone (612) 338-3333
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50017800 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265068800000",
"number": "1689634677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "825 NICOLLET MALL",
"address_2": "SUITE 1149",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554022606",
"telephone_number": "612-338-3333",
"fax_number": "612-349-3838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "825 NICOLLET MALL",
"address_2": "SUITE 1149",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554022606",
"telephone_number": "612-338-3333",
"fax_number": "612-349-3838"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELDER",
"first_name": "MARY",
"middle_name": "ANNE",
"name_prefix": "Mrs.",
"credential": "FNP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-24",
"last_updated": "2010-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MN",
"license": "R1176072",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "50017800",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.