Facts
- Status
- A
- Credential
- Nurse Practitioner
- Type
- Individual
- Enumeration date
- 2019-07-12
- Last updated
- 2022-09-08
Licenses
- License WI
- 9371-33
- License WI
- 9371-33
- License MN
- 9487
Location
- Practice location
- 1601 GOLF COURSE RD
- City
- GRAND RAPIDS MN
- Postal code
- 557448648
- Phone
- 218-326-3401
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.