Basic Information
| Provider Information | |||||||||
| NPI: | 1922452325 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCNIVEN | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | MARIE SPROAT | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD, MS | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SPROAT | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 14000 FAIRVIEW DR | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553375713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529938700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14000 FAIRVIEW DR | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553375713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529938700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2016 | ||||||||
| LastUpdateDate: | 09/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 62683 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.