| NPI | 1235395351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANET RENE HAUGEN Executive Director 218-694-4000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MN 305R00000X) |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2008-07-29 |