NPI | 1538109889 |
---|---|
Entity Type | Organization |
Authorized Contact | NICOLE MARTINSON Director, Revenue Management 651-696-5676 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 01898) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 000713) |
363A00000X Physician Assistant (Licence: IA 000713) | |
332900000X Non-Pharmacy Dispensing Site | |
Enumeration Date | 2006-06-07 |
Last Update Date | 2025-09-23 |