Provider Demographics
NPI:1700290319
Name:SEVERANCE, ELIZABETH (FNP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:SEVERANCE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3849 UPTON AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-1810
Mailing Address - Country:US
Mailing Address - Phone:651-605-5061
Mailing Address - Fax:
Practice Address - Street 1:2401 FAIRVIEW AVE N # 145
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113-2708
Practice Address - Country:US
Practice Address - Phone:763-225-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2412363LF0000X
SC22871363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily