Provider Demographics
NPI:1215133525
Name:FORSBERG, ALEXIS ANN (CNP)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:ANN
Last Name:FORSBERG
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:ANN
Other - Last Name:CONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 PHALEN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-5302
Practice Address - Country:US
Practice Address - Phone:651-254-7870
Practice Address - Fax:651-254-7876
Is Sole Proprietor?:No
Enumeration Date:2007-06-23
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1856363L00000X, 363L00000X
MNR 171714-3363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN38090500Medicaid
WI36051600Medicaid