Healthcare Provider Details

I. General information

NPI: 1669460077
Provider Name (Legal Business Name): ROBERT A NORDLAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 STANFORD CT UNIT 701
NAPLES FL
34112-4813
US

IV. Provider business mailing address

550 S MAPLE ST
WACONIA MN
55387-1763
US

V. Phone/Fax

Practice location:
  • Phone: 239-566-7425
  • Fax: 239-593-3430
Mailing address:
  • Phone: 952-442-2137
  • Fax: 952-442-5960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberLL726
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number19812
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: