Provider Demographics
NPI:1629799481
Name:FUECHTMANN, ELLEN J
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:J
Last Name:FUECHTMANN
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 1:4401 PARK GLEN RD APT 225
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4767
Mailing Address - Country:US
Mailing Address - Phone:763-516-7262
Mailing Address - Fax:
Practice Address - Street 1:4401 PARK GLEN RD APT 225
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-4767
Practice Address - Country:US
Practice Address - Phone:763-516-7262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant