Healthcare Provider Details

I. General information

NPI: 1851468920
Provider Name (Legal Business Name): ANNANDALE PUBLIC SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CHERRY AVE N
ANNANDALE MN
55302-1121
US

IV. Provider business mailing address

PO BOX 190
ANNANDALE MN
55302-0190
US

V. Phone/Fax

Practice location:
  • Phone: 320-274-5602
  • Fax: 320-274-5978
Mailing address:
  • Phone: 320-274-5602
  • Fax: 320-274-5978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: STEVE NIKLAUS
Title or Position: SUPERINTENDENT
Credential:
Phone: 320-274-5602