Provider Demographics
NPI:1063404168
Name:SIQVELAND, ELIZABETH J (CPNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:SIQVELAND
Suffix:
Gender:F
Credentials:CPNP
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Mailing Address - Street 1:2910 CENTRE POINTE DR
Mailing Address - Street 2:35-121A, CHILDRENS HEALTH CARE
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1182
Mailing Address - Country:US
Mailing Address - Phone:651-855-2327
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:347 SMITH AVE N
Practice Address - Street 2:CHILDRENS SPECIALTY CLINIC-GENETICS-STPL
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2387
Practice Address - Country:US
Practice Address - Phone:651-220-6884
Practice Address - Fax:651-220-6248
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR1386079363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q42397Medicare UPIN