| NPI | 1194115790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYA LYNN HAASE Family Nurse Pracititioner 612-916-0593 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: MN R158646-8) |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2015-02-03 |