Provider Demographics
NPI:1760411888
Name:FRIEDHEIM, ANNETTE (NP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:FRIEDHEIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 BEAM AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1126
Mailing Address - Country:US
Mailing Address - Phone:651-232-7970
Mailing Address - Fax:651-232-5720
Practice Address - Street 1:516 DELAWARE ST SE
Practice Address - Street 2:UNIV.OF MN PHYSICIANS, PWB FIFTH FLOOR, CLINIC 5B
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0356
Practice Address - Country:US
Practice Address - Phone:612-626-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 133241-8363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN115291OtherUCARE
MN768118OtherARAZ
MN04-13144OtherMEDICA CHOICE & PRIMARY
MNHP28940OtherHEALTHPARTNERS
MN29T32FROtherBCBS
MN1015990OtherPREFERRED ONE
MNP18100Medicare UPIN