Provider Demographics
NPI:1154423069
Name:MURTAUGH, ANN K (WHNP, ANP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:K
Last Name:MURTAUGH
Suffix:
Gender:F
Credentials:WHNP, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4341
Mailing Address - Country:US
Mailing Address - Phone:763-572-5710
Mailing Address - Fax:763-571-3008
Practice Address - Street 1:6341 UNIVERSITY AVE NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-4946
Practice Address - Country:US
Practice Address - Phone:763-572-5710
Practice Address - Fax:763-586-5927
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR141281-7363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1020264OtherPREFERRED ONE
MN0700841OtherMEDICA
MN928730OtherAMERICA'S PPO
MNHP30007OtherHEALTHPARTNERS
MN47F16MUOtherBCBS OF MN
MN129228OtherUCARE MN
MN7930399OtherAETNA INS
MNP00964Medicare UPIN