Provider Demographics
NPI:1710299227
Name:WESTPHAL, ANTOINETTE L (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:L
Last Name:WESTPHAL
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3706
Mailing Address - Country:US
Mailing Address - Phone:612-545-5311
Mailing Address - Fax:
Practice Address - Street 1:2606 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3706
Practice Address - Country:US
Practice Address - Phone:612-545-5311
Practice Address - Fax:612-224-9622
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300176B00000X
MNR137551-4163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNMW2217190OtherDEA