Provider Demographics
NPI:1649899865
Name:THELEN, ELIZABETH MARGARET
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARGARET
Last Name:THELEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MARGARET
Other - Last Name:DONOVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17050 TRENTON LN
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-3381
Mailing Address - Country:US
Mailing Address - Phone:952-237-0619
Mailing Address - Fax:
Practice Address - Street 1:4100 MINNESOTA DR # 200
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5417
Practice Address - Country:US
Practice Address - Phone:952-996-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2298085163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse