Provider Demographics
NPI:1639825292
Name:TROTTMAN, ANASAS
Entity Type:Individual
Prefix:
First Name:ANASAS
Middle Name:
Last Name:TROTTMAN
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 1:1632 WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2521
Mailing Address - Country:US
Mailing Address - Phone:612-516-8504
Mailing Address - Fax:
Practice Address - Street 1:1632 WALNUT LN
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2521
Practice Address - Country:US
Practice Address - Phone:612-516-8504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker