| NPI | 1548282833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE MARTINSON Director, Revenue Management 651-696-5676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NE 110111) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2025-09-23 |