Healthcare Provider Details

I. General information

NPI: 1003591520
Provider Name (Legal Business Name): ATRACARE WALK-IN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 ATLANTIC AVE STE 4
OCEAN VIEW DE
19970-9116
US

IV. Provider business mailing address

6501 CITY WEST PKWY
EDEN PRAIRIE MN
55344-3248
US

V. Phone/Fax

Practice location:
  • Phone: 302-745-7050
  • Fax:
Mailing address:
  • Phone: 952-653-2565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: LINDSAY ALBANESE
Title or Position: PHYSICIAN
Credential: MD
Phone: 302-745-7050