Provider Demographics
NPI:1710308234
Name:EKMAN, HEIDI (CNP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:EKMAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 STINSON BLVD
Mailing Address - Street 2:
Mailing Address - City:ST ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-1520
Mailing Address - Country:US
Mailing Address - Phone:605-610-6284
Mailing Address - Fax:
Practice Address - Street 1:6405 FRANCE AVE S STE W340
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2195
Practice Address - Country:US
Practice Address - Phone:952-836-3628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 192337-7363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health