Provider Demographics
NPI:1265621585
Name:DORN, ELIZABETH MARIE (CNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:DORN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4178 KNOB DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2888
Mailing Address - Country:US
Mailing Address - Phone:651-209-8640
Mailing Address - Fax:651-209-8690
Practice Address - Street 1:4178 KNOB DR
Practice Address - Street 2:SUITE A
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2888
Practice Address - Country:US
Practice Address - Phone:651-209-8640
Practice Address - Fax:651-209-8690
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1574616363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily