Provider Demographics
NPI:1487232187
Name:ANOTTA, FURTU SEIFEMICHAEL
Entity Type:Individual
Prefix:
First Name:FURTU
Middle Name:SEIFEMICHAEL
Last Name:ANOTTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 130TH LN NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-7059
Mailing Address - Country:US
Mailing Address - Phone:763-516-7420
Mailing Address - Fax:
Practice Address - Street 1:2357 108TH LN NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5222
Practice Address - Country:US
Practice Address - Phone:612-770-8175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNF07202221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily