MEDICARE: NORTHERN MEDICAL & REHAB SUPPLIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)		MN

General Provider Information

NPI Number	:	1417046665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN MEDICAL & REHAB SUPPLIES

Provider Business Mailing Address
First Line	:	18049 KETTLE RIVER BLVD NE
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-8436
Country	:	US
Telephone Number	:	651-464-4991
Fax Number	:

Provider Business Practice Location Address
First Line	:	7761 LAKE DR
Second Line	:	STE B
City	:	LINO LAKES
State	:	MN
Zip	:	55014-1157
Country	:	US
Telephone Number	:	651-784-7965
Fax Number	:	651-784-7964

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MRS. LORI ANN ZARN
Credential	:
Telephone Number	:	651-784-7965

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/22/2020

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