Provider Demographics
NPI:1225111792
Name:ELLIOTT, ANGELA GOLDIE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:GOLDIE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 YORK AVE S STE 303
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2334
Mailing Address - Country:US
Mailing Address - Phone:952-225-5400
Mailing Address - Fax:
Practice Address - Street 1:6550 YORK AVE S STE 303
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2334
Practice Address - Country:US
Practice Address - Phone:952-225-5400
Practice Address - Fax:952-920-7739
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR146842-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNQ34311Medicare UPIN