| NPI | 1811554629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZANNE MARY CARLSON-SHIMON President 651-491-4354 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2019-05-28 |