Basic Information
| Provider Information | |||||||||
| NPI: | 1669603403 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEU | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | JOY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WALDEN | ||||||||
| OtherFirstName: | ANNA | ||||||||
| OtherMiddleName: | JOY | ||||||||
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| OtherCredential: | FNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 824 N 11TH ST | ||||||||
| Address2: | |||||||||
| City: | MONTEVIDEO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 562651629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202698877 | ||||||||
| FaxNumber: | 3202698186 | ||||||||
| Practice Location | |||||||||
| Address1: | 1027 WASHINGTON AVENUE | ||||||||
| Address2: | |||||||||
| City: | DETROIT LAKES | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2188475611 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2009 | ||||||||
| LastUpdateDate: | 08/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R189426-0 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1669603403 | 05 | MN | MEDICAID |