Basic Information
Provider Information
NPI: 1891181541
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MEYER
FirstName: ANNA
MiddleName: CORINNE
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9825 HOSPITAL DR STE 205
Address2:  
City: MAPLE GROVE
State: MN
PostalCode: 553694480
CountryCode: US
TelephoneNumber: 7635877000
FaxNumber:  
Practice Location
Address1: 9825 HOSPITAL DR STE 205
Address2:  
City: MAPLE GROVE
State: MN
PostalCode: 553694480
CountryCode: US
TelephoneNumber: 7635877000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/09/2015
LastUpdateDate: 04/13/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/13/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X65219MNY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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