| NPI | 1629000682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRETCHEN A MOEN President 651-209-8640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 1650) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 1650) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 1650) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN 1650) | |
| 363LW0102X Nurse Practitioner, Women's Health (Licence: MN 1650) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2020-08-22 |