Provider Demographics
NPI:1912986092
Name:FELL, NANCY ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANNE
Last Name:FELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4527 FINCH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:IA
Mailing Address - Zip Code:50450-8016
Mailing Address - Country:US
Mailing Address - Phone:641-592-3678
Mailing Address - Fax:
Practice Address - Street 1:404 W FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2437
Practice Address - Country:US
Practice Address - Phone:507-373-2384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN805363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN368639600Medicaid
MN368639600Medicaid
MN970002337Medicare ID - Type Unspecified