Provider Demographics
NPI:1649243171
Name:HERGERT, ANNA NICOLE (RN, CNP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:NICOLE
Last Name:HERGERT
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 FRANCE AVE S
Mailing Address - Street 2:SUITE W400
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2163
Mailing Address - Country:US
Mailing Address - Phone:952-920-2730
Mailing Address - Fax:952-567-7090
Practice Address - Street 1:6405 FRANCE AVE S
Practice Address - Street 2:SUITE W400
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2163
Practice Address - Country:US
Practice Address - Phone:952-920-2730
Practice Address - Fax:952-567-7090
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1453494363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN949631900Medicaid