Provider Demographics
NPI:1225156227
Name:CONZEMIUS, GAIL ANN (MA RNC NP)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:ANN
Last Name:CONZEMIUS
Suffix:
Gender:F
Credentials:MA RNC NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10979 140TH ST E
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-8515
Mailing Address - Country:US
Mailing Address - Phone:651-437-9138
Mailing Address - Fax:
Practice Address - Street 1:2115 SUMMIT AVE
Practice Address - Street 2:#5056
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1096
Practice Address - Country:US
Practice Address - Phone:651-962-6750
Practice Address - Fax:651-962-6751
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 096379-4163W00000X
MD0093337363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNS01526Medicare UPIN