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NPI Code Detail

MEDICARE: NYSTROM & ASSOCIATES, LTD

MEDICARE: NYSTROM & ASSOCIATES, LTD
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
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790872562
Entity Type Code : Organization
Provider Name (Legal Business Name) : NYSTROM & ASSOCIATES, LTD
Provider Business Mailing Address
First Line : 1900 SILVER LAKE RD NW STE 110
Second Line :
City : NEW BRIGHTON
State : MN
Zip : 55112-1789
Country : US
Telephone Number : 651-628-9566
Fax Number : 651-628-0411
Provider Business Practice Location Address
First Line : 1900 SILVER LAKE RD NW STE 110
Second Line :
City : NEW BRIGHTON
State : MN
Zip : 55112-1789
Country : US
Telephone Number : 651-628-9253
Fax Number : 651-631-8789
Authorized Official
Title or Position : VP OF CORPORATE SERVICES
Name : ANN EIDEN
Credential :
Telephone Number : 651-379-1750
Provider Enumeration Date : 10/05/2006
Last Update Date : 10/21/2025

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Directions to “NYSTROM & ASSOCIATES, LTD ” Practice Location

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